I was very proud of myself for doing two admissions; now I’m bored/tired. I don’t want any more admissions. It’s starting to get through to me that what’s new and exciting to me is very old hat to the residents: they admit 10+ patients per resident, often with very similar complaints, every single day, no matter what specialty they’re in.

Actually, the second one I got was pretty unique: early-teen girl with FAP (Familial Adenomatous Polyposis syndrome – tons of GI polyps, much higher chance of getting cancer), who after a complicated history and a procedure yesterday is now bleeding. This time I had my notes ahead of time, and got all the questions in. The girl was with her grandparents, who are actually homeschooling her and her siblings; and their pastor showed up partway through. It was a very satisfying interaction. I was upset with myself for not being able to come up with a good plan for her (the pediatrics senior residents are really encouraging us to try to think like an intern, and write up everything that needs to be done for the patient), but felt much better after the resident didn’t really know how concerned to be about the bleeding, or what to do for her pain (she was NPO, which rules out pills; and a lot of pain meds can exacerbate bleeding conditions). She paged the attending, and without admitting it, he wasn’t really sure either (and he’s a GI specialist!), and forced her to consult the surgery resident – who was very contemptuous of us all, and with reason, since she was not in severe pain, and clearly had no acute surgical issues. I must say, when so much of medicine is learning by context (gauge how concerned the experienced people are over a range of situations), it’s kind of confusing when their assessment of the situation keeps changing. On a tangent, earlier today I was reading some of Barbados Butterfly’s advice to surgical interns. One story she tells is about how one morning on rounds she and two senior nurses found one of their patients in respiratory distress. Because of their experience, they were able to manage his airway and push a number of iv meds, and thus stabilize him, without calling a code. Later, she realized that she needed to warn her intern that if he ever found a patient in such a case, he needed to call a code right away, because he didn’t have the expertise to manage it singlehandedly as she had. She saw from his face that he had taken the earlier incident for routine, because of how smoothly she handled it.

The residents ended up ordering pizza. To demonstrate my willingness to run any number of errands that don’t involve going out in public, I went down to get the pizza, and signed my best indecipherable scrawl for it, after taking the receptionists’ advice for what tip to put – in front of the delivery man. After that they still addressed me as doctor! I took the pizza to the lounge on the other side of the hospital, then went back to bring some to where the residents are stuck on the floor taking one admission after another.

So, the residents were pretty happy with me, between my good H&Ps, and the pizza delivery service. I examined to see if I’m being altruistic, since I’m not getting paid for helping the patients, I’m not learning a great deal of use, since I hope never to be in personal contact with a bleeding FAP patient again, and these residents, being the call team, have nothing to do with my grade. But I decided it’s so satisfying to please the senior resident at all that I can’t really count as altruistic. In case you were interested.

We’re watching the girl now to see how bad her hemoglobin will get, and what the attending’s tolerance level will be before he decides to transfuse her. The residents are not slammed, but they are getting steady calls from the ER. They sent me to study. There’s a cat-bite patient in the ER; I really hope they let me have that one when he comes up to the floor.

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