My service as of tonight, and more...

For the more medically inclined a run down of the service, all are male:

-35y/o with HIV on HAART for two weeks with crypto meningitis and a CD4 of <50
-81y/o with a ® parietal tuberculoma of the brain, seizures, inability to communicate or locomote for 1 wk.
-54y/o with inability to swallow for 1 wk, and as it turns out a host of other neurological deficits that span the upper and lower motor neuron spectrum with reflexes preserved making this a process that could really have only one diagnosis; ALS. Why is it that the really nice guys get this?
-36y/o with 3rd admission in one month for focal seizures and malcompliance with anti seizure meds.
-51y/o with HIV, low CD4 and ® sided weakness and chronic diarrhea.
-35y/o with HIV and alcohol withdrawal, panic disorder, and a CD4 in negative numbers.
-30y/o with crypto meningitis on day 10/14 of amphotericin.
-37y/o with HIV and now on HARRT with end stage pneumocystis of the lungs and chronic bronco-pleural fistulae necessitating bilateral now unilateral chest tube(s).
-36y/o with bilateral lower extremity paresis c/w with a Guillian-Barre like syndrome but he has had it long enough that is should be resolving to some extent by now. He has bloody emesis and was transfused three units, now more stable but with significantly depressed mental status.
-42y/o with HIV and recurrent TB.
-52y/o with numerous tumors of the lung and presumed mets to the brain.
-49y/o with HIV, DM II, and encephalitis that has improved and will go home soon.
-38y/o with XDRTB (extremely drug resistant TB) who is housed in an isolation ward such that it appears that he is imprisoned.

As I review this list I again marvel at the depth and breadth of pathology; ALS and XDRTB on the same service? I am definitely in the right place at the right time in my career. I miss CGFM to be sure yet this is so stimulating and fascinating, so immediate, requiring a creative approach to everything that I feel truly fortunate.

And as of tonight we have moved! Not lock, stock, and barrel but tonight is the first night in our own digs. The house here is wonderful and the Jones have been amazing hosts, and the bedroom will always be an icon for violation unfortunately. We simply need to have it behind us. I am surprised how insecure I feel at night. I have been in loads of worse places but never have had this happen to me/us and it will be nice to take a step forward. We have high speed internet wireless and will soon have DSL. Life has been good and this is a blessing indeed.

At the end of next week I start outreach and begin it full time in December. Wow, I am indeed blessed. Blessed to have the friends we have thus far with the Jones family at the top pf that list and many people from Gabs, Penn, Baylor, and elsewhere with whom to become better acquainted.