On the intern’s days off this month I get to take care of the floor, since dealing with the myriad annoying details of a busy floor is completely beyond the patience of a chief resident, especially by this time of year (there’s tylenol tablets ordered and the patient would like liquid; patient in ten really needs to be reassured, by the doctor, for the third time today, that the bump on her stomach is normal after surgery; patient in eleven hasn’t voided today – or in fact since yesterday evening; clear liquid diet is ordered, may the patient have coffee (x 3 or 4); please order physical therapy, or the patient will not want/will not be assisted to walk today; please reorder physical therapy, they lost the last order in the computer; please order occupational therapy separately; the patient being discharged doesn’t like percocet, they would like vicodin instead (great, and I already wrote all over the controlled substances script, and have to go get another one from the sub-basement safe deposit, or wherever they keep them these days); the patient has a fever of 100.2 (no, that isn’t a fever, call me when it gets to 100.4, or better yet, not until it gets to 101+); the pharmacy says the dilaudid order for the patient who had surgery yesterday has run out, he’s having pain, and I can’t give him anything unless you reorder it right now) – and I can’t blame him.
Plus some of my favorite floor consults (the patient was going to see your attending next month, but since we’ve admitted him with another acute problem, please fix this one right now), and my favorite ER consults (where my attending knows the patient is coming, and I get labs and CT ordered and my whole admission and orders written up before the ER intern fills out their T sheet; that makes you popular with the ER attendings, and the intern too, because they don’t have to call you).
But for all the sarcasm, this stuff is amazingly easy to deal with. Last year I would have spent at least a few minutes thinking about all kinds of questions, or about the slightly more real dilemmas (how to treat pain when the patient throws up with everything you give them; what to do with a blood pressure of 200/110; is a fever on the night of postop day 2 worth working up, or not); but now I’ve seen enough that this is all reflexive. I’ve finished most of the scut work by 8 or 8:30 am, and have the rest of the day free for the OR, for catching up on the ICU patients, or theoretically for studying. It’s nice to know that I’ve learned something in the last two years, if only how to deal with minor questions fast enough that neither I nor the nurse have time to get annoyed about them.
Next week the schedule picks up, and I should get some more cases. I think the chief thought I had finally taken leave of my senses (which he’s never regarded as very formidable anyway) with glee, when we discussed that part of the schedule.