Best call day ever. I got a whole case for myself. Admittedly just a giant abscess, but so disgusting that the attending didn’t even bother scrubbing, just gave vague directions from the background about where to cut, and the senior resident let me dive in on my own. After all, the tissue was so messed up that a couple millimeters deviation in the incision wouldn’t make much difference in the long run. It was neat, because I had admitted the guy, evaluated him myself and concluded he needed to go to surgery (it took me about five minutes, looking at him; the other surgeons took one glance and started calling the OR folks). I had also gone through the consent with him, which was a little difficult, because I knew the abscess was bad enough that there might be complications coming, but he really didn’t want to hear about them: “Just do whatever you need to do, and if it gets too bad, cut my throat.” “Sorry sir, we can’t do that, but I have to be honest with you about the possibilities. . .” It turned out fine. He’ll have some pain, but no lasting deficits.
Then, the computers broke, so the nurses couldn’t check orders, so they didn’t call me for clarifications or new orders for several hours. I got to sleep for an incredibly long time, and study for the ABSITE as well.
At last an ER resident paged me. “Hi, we have this guy here with appendicitis.” Sounded straightforward enough. Except when I walked into the room, the guy was so psycho, at first I was afraid, from his weird symptoms (as he described them) that he had something majorly wrong with him, worse than I’d been told. About thirty seconds later, after three physiologically impossible complaints, my memory of his CT scan kicked in. It had been quite normal, except for the appendix. Then he started talking about voices in his belly, and the government spying on him, and people forcing him to smoke cigarettes, and I knew he was just plain psychotic. I checked for suicidal or homicidal messages from the voices (none; they were just, naturally enough, asking to get out of his belly), and called my senior. I also mentioned to the ER resident that it might be nice to warn people about what they’re walking into when sending them to see psychotic patients. My senior, who hates to admit anybody, even people who are having surgery in five hours, was strongly tempted to call psychiatry on the spot. Since they won’t admit people who have even simple hypertension, I persuaded him that the best thing to do would be to simply proceed with surgery so we could get the guy off our hands as soon as possible. Last I heard, he’d been sent to the floor to wait for the OR to be set up, and was driving his roommate crazy.
This morning, trying to get out of the hospital, I decided that I’m way too successful as an intern. For you folks out there who wonder about my relationship with the nurses, don’t worry. They trust me enough – and know that I’ll be polite enough – that they ask me all kinds of questions. “We have Dr. Alice here, let me just check on that.” “We can handle this patient with xyz bad problems, because Dr. Alice is around. If it was someone else, they’d have to go to a higher level of care; but we know she’ll be available.” “Dr. Alice, your patient in room 3 is complaining about [insert any ridiculous non-problem]. Could you just settle her down?” It makes for good care for the patients, because we communicate a lot and take care of things quickly, but it makes it hard for me to get out of the hospital, or even off the floor.
The other thing that delayed me was a test we’d finally done on a patient who’s just been lingering around, not getting better, several days after his surgery. Yesterday, after having talked with the fellow, I tried to talk the attending into doing the test. He gave me the usual barrage of questions, and although I argued the point, I backed down. Today, the patient was just slightly worse enough that the fellow and I announced the test to the attending as a fait accompli: We ordered it, we’ll let you know the results. It came back majorly abnormal, and now the people on call for the day are going to spend a lot of time trying to fix things. Moral, this attending really is just messing with my mind. Just because he questions my ideas doesn’t mean they’re bad. We didn’t lose anything by waiting a day, except leaving the patient in limbo wondering what was wrong for an extra 24 hours; but next time I’ll stick with my instincts a little more.