My service got hit by an avalanche today. We halfway saw it coming, knowing what the OR schedule was, but half of it was through the ER. The only good thing is that almost everyone was genuinely sick. It’s much more fun to take care of sick people who get thrown into your lap, than not-sick people who have to have the paperwork done anyway.

I got to spend a fair amount of time in the OR, with one case which was at my level, and one senior-level case which I was thrilled to land in because there were simply no other residents free in the entire hospital. Of course, I paid for it by drowning in floor work whenever I left the OR. I was pleased beyond words to be operating, but it was frustrating not to be able to take care of my patients as carefully as I usually like to.

We got a few disasters dumped on us from outside hospitals. Another patient with truly peritoneal signs. I love getting called by the floor secretaries: “Your attending accepted this patient in transfer from Hospital X. I don’t know why he’s here. Oh, I guess he has abdominal pain. No, I don’t have any idea what they diagnosed him with. He has no papers with him. Oh wait, there are some CT scans. No labs. Oh wait, here are some labs. Yeah, he looks great.” That didn’t sound very reassuring. I went up to see, and found the poor guy literally fulfilling the cliche description of peritonitis: jumping off the bed, hitting the ceiling if you touched him. The front page on his records from the other hospital said, “perforated bowel.” Clearly the people who arranged his transfer with my attending hadn’t mentioned that, otherwise the attending wouldn’t have been content to let him drift around on the floor like that, trusting to chance that he would get noticed. The OR scheduling staff started to cringe when they saw me coming, because of the number of cases we added on today.

Beyond that, half my patients on the floor developed surprising new conditions requiring urgent attention, and nearly all of the postop patients deviated in some way from the proper course, ranging from low blood counts requiring transfusion to aspiration requiring stat reintubation.

Under these circumstances, when the nurses called to tell me about a patient with panic attacks who was clearly inventing wilder and wilder symptoms because I wasn’t coming to hold his hand, I felt justified in ordering a simple rule-out test, and then proceeding to ativan. I trusted the nurses to let me know if it was anything more than a panic attack, and they didn’t mind me ignoring them, because they could see all the other real disasters on that floor.

Just to add to the fun, most of the other surgery services were getting similarly slammed. Some of my urgent add-on cases got bumped by even more emergent add-ons from other attendings, and as late as I left, half the residents were still working in the OR, or picking up consults in the ER. It’s funny how different patients respond to having me check on them at 8pm and promise to return early the next day, from “you’ll be here in the morning? oh good, I trust you” to “you’ll be here in the morning? do you ever sleep?” To both of which the answer is a smile and a quick escape out the door.

Tomorrow is going to be a bad day, mopping up, even if nothing more hits the ER tonight. And with my attending’s luck so far today, I fully expect to find three more seriously ill patients on my list tomorrow.