Tonight was amazingly quiet. We admitted one patient of that special genre distinguished by the fact that the ER residents run the other way when they see her name on the list, the nurses fight about who gets to not have her, and when we sign out in the morning, the team lucky enough to have received her says, “Explain to me the difference between her three admissions last month, this admission, and her scheduled admission later this week?” And we can only shake our heads. Sorry, no difference. She picked this night to spend in the ER, that’s all.

Neurosurgery had some dramatic head bleed (there I go talking in undistinguished general surgery/ER terminology; I didn’t get a long enough look at the CT to see whether it was epidural or subdural; it needed surgery, either way), and my beeper was quiet, so I tagged along. We had just finished the flurry of setting the patient up, and the residents were starting to scrub, when my beeper went off. Brad had picked that moment to review the issues of every patient on the floor, and provide a long list of errands that I hadn’t previously recognized the existence of. The neurosurg attending walked on, and made as though he recognized me, and would welcome my involvement in the case, and all I could do was wave hello and run out the door. (Brad had suggested that one of the patients might be on the verge of intubation; they ended up not being, but of course I didn’t know that till I ran up there.) That’s the last time I’m going to hang around neurosurgery. All I did was look dumb, and feel sad that I couldn’t join them, and distract myself from my proper work. (Interns are not supposed to be in the OR, not supposed to come in later than 5am, and not supposed to stand still for more than two minutes. This last was tested with my friend on the trauma team a little later, as we stood around jabbering while waiting for innumerable xrays on innumerable potentially broken bones to be completed. We both started fidgeting after about two minutes of catching up, with the sense that something was very wrong if we were doing nothing for so long.)

And then there was the call from the monitored floor at 5:30am (half an hour before I get to leave): “Mrs. X has been having really weird rhythms all night. Would you like an EKG this morning?” I flew up to see, and sure enough, there were some really weird rhythms on the monitor records. PACs, PVCs, junctional rhythms, brief Vtach x4, and a whole bunch of jumbled things (not artifact) that neither the techs nor I could explain. Mrs. X, fortunately, was asymptomatic, so I was left to ponder the nurses’ decision that 1) I didn’t need to be called earlier, but 2) I did need to be called now. I didn’t get an EKG. She’d had one the day before, as well as a full cardiac workup, and her history of such rhythms is so long that she’s almost able to recognize them herself, from watching them on the monitor on her repeated hospital admissions. In fact, her main complaint this morning was that there wasn’t a monitor in a good position for her to watch, since she’d like to know what it is that keeps making everyone pop in to check on her every half hour all night.

(Just so you don’t think I dislike all the nurses in the hospital, let me also mention the nurses who call me with things like: “Mr. Z fell out of bed, but he’s ok, you don’t need to worry about him; I ordered restraints and a low bed for him, is that ok with you?” Or, “Mrs. Y pulled her NG out accidentally, but it was still putting out a great deal, so I figure you want it back in, right?” (The miracle here is not asking me to do it.) Or, “Your patient who’s on heparin and coumadin for the last three days doesn’t have any ordered for tonight; would you like to order it before it’s too late for him to get tonight’s dose?” The kind of things that I could never hope to know about, since no one signs out that they forgot to order coumadin tonight. Our hospital has a ridiculous policy of having to order each day’s dose of coumadin separately, which tends towards such oversights. I suppose it’s safer than tending to repeat doses that are higher than necessary, but it’s a nuisance.)