From rounds:
Med student: “. . . Besides which, her white count is up today from 16 to 18,000.”
Attending: “What’s the difference between 16,000 and 18,000?”
Med student (obviously thinking he’s got an easy question this time): “Um, 2,000?”
Attending: “No, zero, because it’s within the range of lab error.”
After which the chief ordered cultures anyway.

From the OR:
After we’d moved the patient from the OR table to the bed:
Anesthesia resident: “He’s desaturating. . . ambu-bag, please. . . this isn’t working, I’m going to have to intubate him again.”
Surgery resident, to the ceiling: “Interesting, that’s exactly what happened last time.”
Anesthesia resident, curious: “You mean this happened before?”
Surgery resident: “Yes, when we did the first surgery four days ago, he had to be reintubated after moving off the table. Good thing he’s got an easy airway.”
Moral, not to assume that people know things. You’d think that such a significant event occurring only a few days ago in this very hospital would be mentioned between members of the anesthesia team caring for this guy; but I guess not. It’s our fault, anyway, for assuming that the anesthesia resident knew what had happened. We should have told him. Better to remind your colleagues of something they already know, than for everyone to overlook an important fact. (The patient is doing fine.)

From the floor:
Nurse: “You’d better come see this patient. Something’s going to happen.”
Me: “Why, what are his vital signs?”
Nurse: “Pressure’s ok, but he says he’s got to go see the Blessed Mother, that she’s in the room calling to him.”
Me: “See who?” (I’m not used to the Catholic phrases that are so common around here.)
Nurse: “Mary and Jesus. He says they’re talking to him. You’d better come. The last three patients who told me that died within an hour.”
Fortunately, this patient didn’t. We had a long and rather wild delirious theological conversation with him, attempting to persuade him that Jesus and Mary could wait for a while (good thing at least one of the nurses was devoutly Catholic too, since my Protestant tendencies are too strong to allow me to discuss visions of the Blessed Mother with a straight face). The next day the anesthesia drugs finally wore off, and he became quite lucid; still devout, but not as frightening.

Other than that, this service is starting to get to me. Too many cancer patients. I guess I didn’t realize how much cancer showed up in general surgery; I thought you had to go into surgical oncology to get this involved. We sent yet another patient home to hospice today, we added on an emergency case for which the final diagnosis is probably going to be cancer, and we shortened the OR schedule considerably by opening one of my favorite patients, taking a quick look and a few biopsies, and sewing up again because the cancer was so widespread. Then there’s the poor little lady with advanced cancer who looks like a skeleton, literally. She’s scaring the nurses, because you have to watch for a couple minutes to be sure she’s breathing. They keep moving her closer and closer to the nurses’ station because she makes them so nervous. For some reason, the attending hasn’t talked to her and her family about DNR status yet, or at least hasn’t signed the papers,¬†which makes signout pretty uncomfortable: “And then there’s Mrs. Smith, whom you know; she’s still a full code, I’m sorry, I’m really hoping it doesn’t happen tonight.”

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