My med student tonight confessed to being a black cloud. It was either that, or my four nights of complaining about inactivity finally boomeranged on me. My beeper went off non-stop, the three-pages-at-a-time way, for the first half of the night, and barely slowed down for the second half. Once again, Brad was similarly tied up in the ICU, so I spent several hours running around, trying not to imitate a chicken with its head cut off, juggling way too many people with chest pain, shortness of breath, tachycardia, fever, and low urine output. (Not all in the same person, thank God.)

Partway through, amid a flurry of non-serious trauma pages, a real code came in. I went down to hang out, and the chief waved me in. “You want to do the chest tube?” “I’d love to.” Sotto voce: “Um, have you ever done one before?” This was actually one of the few procedures I did as a medical student, so for once I could reel off the landmarks and steps. It went fairly smoothly (amazing how much violence a patient will let you perpetrate with enough lidocaine in the area), and at the end the chief confided, “Thanks for doing that; I really hate chest tubes.” Any time, man, any time!

In between all this, there was a medicine patient crumping accelerando, whom they kept paging me about. Folks, I really like medicine people, but distended abdomen ≠ surgical abdomen. If you can press into it, it’s not rigid. If you say “acute abdomen,” it means you seriously want the OR team paged in and the patient rolled down within an hour. I’ve been laughed at enough by surgeons for saying “acute abdomen” that I’ve learned not to say it unless I mean it. I’m sorry that your patient is tachycardic, febrile, confused, and short of breath, but doing an exploratory laparatomy with negative results is not going to make him any better. Running some fluids wide open might help with some of that, considering as he’s been oliguric most of the day. I don’t understand the medicine team’s reluctance to do things like place foleys, NGs, central lines, and arterial lines. To us, those are simple, minimalist interventions. One more reason to stick with surgery, I guess.

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