American College of Physicians: Internal Medicine — Doctors for Adults ®

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Food for thought

From the November ACP Hospitalist, copyright © 2012 by the American College of Physicians

By Melissa Lyle and James S. Newman, MD, FACP

Newly minted physician Ima Starvin withdrew her arm from the sanctuary of her down comforter to silence the buzzing of her alarm clock, then promptly fell back asleep. Twenty minutes later, she sat up with a start. She could not be late again! It was 6:20 a.m., her shift started in 10 minutes, and it was a six-mile drive. She was not about to be known as the “tardy-tern.”

Throwing on an almost-acceptable white coat over wrinkled scrubs, Ima raced out her front door two minutes later. No makeup and definitely no time for breakfast…again.

Courtesy of Dr. Newman.

Courtesy of Dr. Newman.



Her stomach growled as she rode the elevator to the fifth floor of the hospital. Morning report had already started but she was not too far behind the crowd. “I'll get something at conference. They always have food there,” she mumbled to herself.

Of course, when she got there, all the donuts and bagels were gone; the locusts had done their work. All that remained was a lone cream cheese container. She idly thought about eating the cream cheese with a knife, but before she could make her move it was snatched away by a ravenous medical student. Reaching her hand into the pocket of her white coat, she found only her green Pocket Medicine book. The reserve granola bar she usually kept there had already been devoured last week during a similar food emergency. It was going to be a long hungry morning till noon conference. At least it was “Hot Lunch Tuesday”!

Ima was grateful to begin rounding on her patients, and the census was stuffed with mouth-watering cases. The first was a 40-year-old woman, post-Roux-en-Y gastric bypass, with a copper deficiency from malabsorption. The second recently had a percutaneous endoscopic gastrostomy tube placed due to amyotrophic lateral sclerosis and an inability to self-feed. The third was a patient with a bezoar who had been eating hair and under-ripe persimmons.

Multitasking throughout most of the morning, Ima almost forgot about her hunger pains. She quickly remembered when the food service woman almost ran her down, charging straight ahead with her tray trolley, which seemed more like a silver bullet than a food cart full of lunches. She was headed to one of Ima's patients' rooms.

The patient was a homeless man who presented to the ED with extreme abdominal pain. He was admitted to the fifth floor and was receiving his lunch while waiting for a gamut of tests to be performed. As the lunch arrived, his abdominal pain miraculously disappeared. The consultant quipped that this was the dreaded “Munchie-hausen syndrome.”

Ima glanced at her watch: one final patient to be seen before Grand Rounds. Bending over the patient to listen to his heart, she jumped when she heard a loud knock on the door.

“Room service!”

A young woman sauntered in, balancing a food tray in one hand and a clipboard in the other. “Here you go!” she piped, as she placed the tray on the patient's bedside table. The aroma of the food tantalized Ima's olfactory nerve, and she found herself wondering how inappropriate it would be to ask her patient for a bite.

She gave a hurried goodbye to her patient with the promise that she would return later to check on him. Dodging nurses and weaving in between people in the halls, Ima raced towards the auditorium where Grand Rounds were usually held. Fantasizing about a warm dish of pasta, Ima trailed into the room at the end of the food line. She waited her turn, slowly watching the serving bowl empty. Then it was her turn.

Pasta and a slice of chicken. She reached for the serving spoon…and her pager went off. Her patient was coding. She stared longingly at her plate, then ran to answer the call of duty.

Once the patient was saved, Ima's victorious feelings soon faded as she wondered if there was time to go to the cafeteria for a quick snack. At that moment, her pager buzzed again. She returned the page and was informed that one of her patients had hypophosphatemia. After further investigation, Ima determined that the patient, an elderly malnourished nursing home resident presenting with anorexia, had refeeding syndrome from total parenteral nutrition.

As Ima dealt with crisis after crisis, the day dragged on. Ima revved up her metabolism as she ran up and down the halls. Parked outside her medicine team's workroom was one of the food carts that had attempted to run her over earlier in the day. Now, it was filled with half-eaten trays of food, mocking Ima as she ran in and out of the workroom station. She started to reach for an uneaten cookie, then realized it was from the room of a patient with Clostridium difficile and vancomycin-resistant enterococci. Maybe she wasn't that hungry.

By 9:00 p.m., all the notes were finished, orders completed, and labs reviewed. Ima grabbed her bag and headed for the door. Every muscle in her body ached with exhaustion, and she yearned to be at home, eating a nice dinner. Did she have any food in her house? She couldn't remember the last time she had time to venture to the grocery store, but she convinced herself she could whip up a gourmet-esque meal for herself, even with limited supplies.

When she arrived home, all Ima found were bare cabinets and an empty refrigerator with a lone carton of skim milk. She reached for the cereal from the pantry and poured the last crumbs from the bottom of the box into the bowl. As she began to pour the milk, it glopped out in malodorous clumps. Ima slumped to the couch.

At the beginning of her intern year, she had been hungry to gain all the knowledge possible. Now, Dr. Ima Starvin was just plain hungry.

Melissa Lyle is a fourth-year medical student at Mercer University School of Medicine in Macon, Ga. Dr. Newman is a hospitalist at Mayo Clinic in Rochester, Minn. and the editorial advisor and humor columnist for ACP Hospitalist.

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