Hi everyone this is Shreya. Today is a special day because it marks the first episode of a new

segment on Cor I am called At the Bedside. I just felt like we couldn't call this podcast

Core I am if we didn't have a space for the more complex

conversations that are core to internal medicine. In fact, core to all of medicine. These are the not so straightforward

situations that happen, for for example in the family

meetings or in the team rooms. I just want to preface though how hard of an undertaking

these episodes were and are because unlike putting together a five purls on a clinical

topic, a lot of these topics don't have a right answer or a step-by-step guideline.

So some of these episodes will delve into personal stories,

and some with more messy topics that don't have very clear takeaways,

but are still really important to explore.

And with that, I will leave you in the trusted hands of

the hosts of at the bedside. I'll let them introduce themselves.

Hi I'm Marco Hedlund an Internal Medicine resident at NYU.

I'm Joff Rolmandri, a hematology oncology fellow at UCLA.

And I'm Tamar Schiff. I also trained in internal medicine and I'm especially interested in medical education and bioethics.

And with that, Margot will lead with an experience that was pretty thought-provoking for her. In this episode, I want to come to a better understanding of the patients that we struggle to take care of, patients who are sometimes called difficult.

Difficult means something different for everyone, but for me this is a patient that I took care of in July of my second year.

He has decompensated cirrhosis, alcohol use disorder,

and former opiate abuse currently on methadone, and he comes in every few weeks requiring a large

volume paracentesis and a large dose of benzodiazepines to keep him from going

into delirium tremens. Unfortunately he lives on the streets and has no access to a bathroom when he leaves the hospital.

...