We arrived this morning to find that our friend the psychotic alcoholic had not left yesterday afternoon, but had disappeared in the wee hours of the morning. Also it appears that the police of another town in the state have a warrant out for him, so all the VA computers flash warnings to anyone who looks at his chart: “notify police as soon as this patient is discharged.” Well, he wasn’t discharged, so who knows if the police will find him. He shut the door on himself and my resident at one point. She was terrified, but thankfully before the situation progressed the intern around the corner walked in and ordered the guy out. Even professional women appreciate chivalry at times like these. Later on the patient threw a phone at a nurse, so now all the nurses scowl and point in the opposite direction if I try to ask questions about him.

So the status now is that he’s gone, and psych hasn’t written a note to say they told us he was competent and non-suicidal, non-homicidal. Which leaves the main documentation as my note saying that he is psychotic, suicidal, and homicidal. And I don’t care what that psychiatrist said, if the person can’t even stand to listen to you ask him to sign out AMA (against medical advice), he is not in his right mind. I am left with the thin hope that I can’t get in trouble for noticing a fact that I was powerless to do anything about.

On a more cheerful note: this morning the attending, a hematologist-oncologist, took us around to his lab again, and it was once more my turn to look at the slide and assist in discussion. The subject was autoimmune hemolytic anemia, complicated by MI in a young person for lack of oxygen-carrying cells. The trick is that you should transfuse the patient in spite of all the compatibility tests being wrong, because in this case there will be no dramatic cell lysis, just the spleen slowly tearing the cells up.

Then, as everyone was walking out, the attending announced, “I want Alice to stay.” So I sank down on the chair. End of the month, time for evaluations, but why just me, not the other student? He asked what I want to do when I grow up, and I said I’m planning on OB/GYN. He pointed out that I hadn’t done that rotation yet, and then began saying I’m very knowledgeable, and would make a great internist, and in fact a great subspecialist, and he would love to write a letter of recommendation for me. I was flabbergasted. Two quiz sessions where I stumbled on the right answers (and he’s overlooking my very lame performance in rounds the last few days), and he’s inviting me to do heme/onc, and offering letters of recommendation?

If there’s anything I don’t want to do, besides radiology, it’s heme/onc; but you can’t possibly say that to such a compliment. So I stammered that I’m enjoying internal medicine, and thank you very much, and staggered out. But what a lovely confidence-booster. God, send that the ob/gyn attendings are this easy to impress!