So it's a Saturday morning and you're making leisurely rounds when a consult comes in for an ICU patient. You show up at the same time as the GI guy who was also consulted. The patient is at the extreme terminus of age. You and the GI consultant review the data together. He had come in through the ER from a nursing home with mental status changes and fevers. His WBC was elevated. A CT scan done the night before showed thickening of the colon from the splenic flexure all the way down to the distal rectum. You walk in and the guy is about to be intubated. He's on three pressors, all maxed out. His belly is soft but you can't really trust your exam. The nurse states that he "just had a seizure".
-Looks pretty bad, you say.
-Yeah. I think I ought to do a quick flex sig to see if he has any pseudomembranes (a sign of c. difficile colitis)
-Ummm...doesn't really matter either way, you offer.
-Yeah, but it would be nice to know. Then we can at least start vancomycin enemas. And with you on board, depending on what the family wants...
-This guy won't be undergoing any surgery, you say. You give him one of those looks, a look that is supposed to transmit a deeper, unspoken meaning---a look that always seems to work in the movies or in bad crime novels, but never in real life. He is already paging his endoscopy team to come in with the equipment.
You move on to the next patient on your list. A little while later a code blue is announced over the intercom as you pass the endoscopy nurse wheeling the unwieldy endo cart toward the ICU.
-You might as well put that thing away, you say.