Last night was slightly better, as in none of my patients crashed, I didn’t have to talk to any of the people involved in last night’s debacle, and that patient continues to do crazy things, but seems to be surviving them. One of his nurses paged me tonight: “Alice! I knew you would call me back. I’ve been calling cardiology and pulmonary, but they don’t answer me.” I guess sometimes reliable is better than – intelligent. I managed, that time, probably because I was more awake than the consultants had been.

One of the services I cover is in a permanent state of disarray, so sign-out consists of: these patients had surgery today, those ones are having surgery tomorrow please make sure their papers are in order, I don’t know what these three people are doing on our list, look here are two new consults could you see them, and oh here are two new admissions, I have no idea what they’re doing here, please see them and write orders. To which I say, helpfully, let’s call the OR office and see what these mystery patients are booked for; let’s call the nurses and see why they were admitted; let’s look up the orders and see why the consults were placed. I’m trying not to be frustrated with the guys who sign out, because 1) they’re definitely out of their depth, and 2) the service is so insanely busy that even with the best will in the world and the strongest work ethic, they still wouldn’t really get all the work done. I have to keep reminding myself to withhold judgment until I do this service myself in a few months. It’s a sign of how hard they’re working that the patients they have had time to see and work on are usually in very good shape and need little help overnight. I’ve had other interns who signed out as though things were cleaned up, but then their patients had disasters all night, which turned out to have been brewing all day and had never been attended to.

An interesting call from the ER: “This man was brought in with suicidal ideation, and we found incidentally a vascular lesion. Come and give clearance so psych can admit him.” I had some difficulty to persuade the ER resident that, however suicidal the guy might have felt, his current weakness was not due to intentional neglect and a will to die, but to pure medical illness. Once you get old enough and have a long enough medical history and medication list, suicidal ideation ought to be a diagnosis of exclusion. Calling psych, for this resident, was easier than finishing an extensive and frustrating workup.

Funny, now that I’ve collected a small stack of useful textbooks, my free time at nights has evaporated. Shoulda known it was too good to last.

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