In continuing a story about Larry (see previous post) I thought I'd give a little more information about his 4 night stay with us in the hospital. He is a 40 something year old obese male with congestive heart failure (CHF), acute renal failure, and a possible GI bleed. Our work up for the GI bleed on day 1 was to do a fecal occult (checking to see if his stool had blood). On day two we got the results---it was positive. So we scheduled a barium enema for the next day. That night Larry needed to drink about 4 liters of "go lytely" which washes your whole system out. I spoke to the RN to see when he should start, they suggested 5pm. So I wrote the order to start at 5pm and then for him to be NPO (ie nothing in the mouth) after midnight---standard orders before this procedure. Well on day 3, I went to visit my friend Larry to discover he had only finished half of his go lytely. Why ? you might ask. Apparently he was sleeping at 5pm and the RN didn't want to wake him. He started the 4 L at 8pm and wasn't able to finish it before midnight---at which point the RN made him NPO. This means no barium enema for Larry. Frustrated, we kept him NPO that day and had him finish the go lytely and rescheduled for day 4. On day 4 he he was ready to go, but we get a call from radiology saying he is too big to even fit in the CT machine. No barium enema for Larry ever. What do we do? We discharge him and tell him to follow up with his outpatient physician.
Gotta love our health system.
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