Or, very little. Two people came in on Thursday, and they were only intubated because the helicopter people are way too eager to intubate people. They say they were “combative,” so there you are. They had no injuries, not even any lacs for me to sew, their CT scans were negative, and they were extubated after a few hours in ICU. I followed them up to ICU, and got the nurses to let me draw ABGs on them. Today, since things look slow again, I’m going to go to the ICU, look up my poor intubated lady, and then ask all the nurses if there are any other ABGs on heavily sedated patients that I can do. Most patients who are there for a while, though, get arterial lines placed, so they don’t have to be stuck again and again to check on pH and oxygenation.

The most exciting thing that happened was an attending who had been away to a conference for the last week came back, with a splash. He’s very decisive, and acts like he knows everything, which inspires confidence, but he also is very rough on the residents, constantly questioning their decisions, and putting them on the defensive. His style of pimping students on rounds is to act like their answers are wrong, and see if he can get anyone else on the team to contradict them, before finally admitting that they were correct. So, not too bad, since I knew the answers; but he certainly makes for very tense, dramatic rounds. I don’t like his style of talking to patients, which is as abrasive as his manner with us – going up to a sedated patient, shouting their name, and shaking them, to see if they’ll respond. He did that with our poor brain-injured teenager, and I could see the nurse cringing, and longing to lash to back at him. . .

I did admire his actions about another patient, a guy who was in jail for a few months for drug possession, who had seen a psychiatrist before, was on psych meds, but then the jail stopped them part way through his time, and he finally hung himself – unsuccessfully, since he turned up on our service. His face is certainly interesting. His eyes are completely red. Anyhow, he has an officer outside his door all the time, who wants to get him back to jail, since he’s not actually injured. The psych nurses who assess possible psych conditions all over the hospital saw him, and wrote in their note that he could be discharged, and should follow up as an outpatient, and gave him a mental health services phone number to call.

The attending was understandably angry with this. Any other patient who came in with such a serious suicide attempt would automatically get at least a two-day stay in the psych unit, after the medical team cleared him. So why the psych people should be able to brush this guy off, just because he came from jail – the attending started spluttering at this point, and I very much enjoyed having him say all the things I thought. The officer said that, in jail, he would be checked on every ten minutes. Ten minutes is plenty of time to kill yourself if you try; a hanging could be complete, in that time. So the attending called the psych nurses and pestered them, and called the psych attending (the same one who terrorized the medical students back at the beginning of this year) and pestered him, and ordered the residents by no means to discharge this guy out of the hospital till he’s seen by a psych attending (not a nurse), and given at least some medicines, if not taken upstairs for a while.

Not that I have much sympathy for “anxiety” patients, or people who attempt suicide unsuccessfully; but it’s so hypocritical, to take all kinds of homicidal and suicidal and uninsured patients, and then turn around on this guy. The psych attending is sauntering around our unit looking cheerful, so I think he’ll be agreeable and help this patient out some.

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