Yesterday was good. The resident started off the day by not paging me – again – for a new admission. But late in the day I figured out that at least half the times I’ve thought he’s ignoring me, it’s actually because I had the wrong pager number for him.

Right as we finished lunch they were paged for a patient who had extubated herself, and needed to be reintubated. So we hurried along up, praising the nurses for calling us before she actually coded. The woman weighed about 350 pounds, and kept biting the intern when he tried the intubation. So then the resident tried. They kept trying different drugs to sedate her. The one they really wanted, which is designed to work within seconds especially to help with intubations, the pharmacy took 25 minutes to send up. But I didn’t mind, because I was actually being useful. Someone decided the O2 sat monitor she was linked up to wasn’t accurate, and got another handheld one, which had to be poked every minute to make it keep reading. So I got to hold onto that, and call out the sats every few minutes, and hold her hand to keep her from fighting with the resident.

All the while they were struggling with the intubation, both the intern and the resident were being paged. So when it was all over we went down to the ER, and were handed three patients at once. The resident understandably didn’t appreciate this, but again I didn’t mind, because he handed me the first patient to go talk to by myself. The guy was lying on the stretcher, in restraints, fighting in an amiable kind of way with the bed, and talking to the ceiling. I’d like to tell you what all he said, but it was so incoherent I can’t even remember any of it, and so crazy I can’t make it up again. After he told me three different things about whether he’d been having a fever, I decided to try for a psych type of interview, and asked him where he was. He said he was in “a lush resort over the stairs, because that’s where it’s cool, right?” I asked him if he was hearing any voices besides mine. He said no, then looked over his shoulder, and said, “He’s a nice guy, but he hangs on to a lot of the money.” I asked if he was seeing anything besides me, and he said no, then looked at the foot of the bed and observed that the sheep were a nice pink color. The girl who was sitting in the room to keep an eye on him rolled her eyes along with me. I was about to march out to find the ER doctor and ask why they hadn’t consulted psych instead of us, but fortunately thought to ask the girl first, and she said she heard he had a white count of 22,000. Ahh. So we ran through a whole differential diagnosis, with all kinds of infections (but he didn’t have a fever), psych things, toxins, and so on, and admitted him. Later on, after dealing with the other patients, the resident wanted to do an LP (lumbar puncture) on him, but before that happened I accidentally ran into a female friend (uncertain etiology) who said he used huge doses of tranquillizers, and ran out seven days ago. So that settled that. He’s in benzo withdrawal. At least he’s more typical than the other “benzo withdrawal” guy on our service. The resident was so impressed with me for being in the right place when the female friend appeared that he assigned me the patient to follow. Great; but I’m getting a little tired of seeing only the neuro branch of our service.

The second patient was pretty sick with cholecystitis, so I also got to see the third patient, a “R/O MI,” as we say. That is, rule out myocardial infarction; a person presents with chest pain, serious enough that you want to keep them in the hospital overnight and check to make sure. But the nomenclature also suggests that the presentation isn’t typical enough to make you very concerned about a heart attack. Scut work for the residents, but I was once again easily pleased by the chance to do her whole history and physical myself. She was nice. Those three plus the one for the morning met our cap for the day, and then overnight we were so incredibly lucky, the night float team didn’t admit anyone for us.

I just noticed that I’m doing what all of the books and articles written by patients about rude doctors and nurses say not to do: referred to patients by their disease, and not by a name, or some other identifier. Part of it is that it’s way easier for me not to have to make up pseudonyms on here. On the floor, most of the conversations I’ve heard actually refer to patients by room number – neither name nor diagnosis. I think it’s part of the impact of shifts: the nurses may know what room number they’re taking care of, but will not recognize the patient’s name as easily. This doesn’t mean they don’t know the patient; when you see someone, you remember all about their personality and particular needs.

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