I’m on call today. Amy’s going to that nursing party tonight. I was actually looking forward to it. But here I must be.
[ … 6:21 AM … ] My alarm was set for 7 a.m. this morning. For some reason I woke up early and unhappy. A few things were going through my head that wouldn’t let me get back to sleep. Strangely enough, I still hear the Clinic Director asking me if I really want to go into medicine. That question still makes me angry and if he asked me again I would tell him it was “severely inappropriate to ask that at this point.” Other things woke me up too, like the presentation I have to give next Friday (on what I don’t know yet). So I checked my email to see if I had anything new that would make me feel better, but I believe I’ve burned some of those bridges too. I’m so good at that you’d think I sweat gasoline. I’ve got a headache now. That extra hour of sleep probably would have helped.
[ … 2:17 PM … ] Hooray! I got my Christmas bonus today! It’s not such a bonus since it’s actually taken out of the monthly checks and given back each December. The 2nd year resident next to me is complaining that his intern is still talking to a new patient he gave him 2 1/2 hours ago. Some of the interns are still a bit inexperienced in the first half of the year. I have my sub-intern/4th year student seeing a new patient in the ER now — an old lady with a new seizure and a bladder infection. Sounds nice and easy so I gave it to my student. I’ll save the “train wrecks” for the intern. Other than that, all quiet on the midwestern front, for now.
The post-call senior just signed out his patient list to me. I recognized three patients on his list that I had 2 months ago. Two of them are “frequent fliers,” patients who get sent home only to come back shortly after. These patients are usually the ones who never really get better. The other kind of “frequent flier” are drug-seekers, which is the case this time. The third patient I recognized has been in a coma for the past 5-6 months. Previous to her current purgatorial existence she was a young woman with occasional asthma. Her last asthma attack was brought on by cleaning chemicals and then she stopped breathing in her car while her husband was racing her to the hospital. At least she’ll be stable tonight … she has been for the past 6 months.
[ … 7:50 PM … ] It’s not even 8 p.m. yet and my team is finished admitting their last patient for the evening. In laymen’s terms that means “SLEEP” unless someone codes or crashes tonight. We have a Russian man with pneumonia whose name happens to be “Monya.” When I was telling his wife he had pneumonia, he thought I was saying his name and he kept asking “what?”
We also admitted a man my age with “membranous glomerulopathy.” I don’t know that much about it either other than he pees out protein and requires steroids (I’ll have to read up on it tonight). He’s here because he had some “bad rice” yesterday and threw up a few times. Maybe he went to the same restaurant that our 31 year old chef with acute hepatitis used to cook at. I’ve also got a 21 year old man with either “mono” or an infected heart valve (endocarditis), we’re not sure yet. A lot of young people on our service lately. Very odd.
[ … 8:02 PM … ] Damn! My intern just called me. I’ve got to put in a central line (a LARGE bore I.V.) into a patient’s groin now. He’s a bleeder and he needs blood now. What a pain. On the other hand, it will probably hurt him more than me. But that’s the way medicine has always been.
[ … around 8:30 PM … ] VAS (my intern): “So what happens if there’s a CODE while we’re trying to get this line in?”
ME: “One of us goes, and one of us stays.”
VAS: “It shouldn’t be this hard to find a pulse, should it?”
ME: “It is in someone this big (the patient is 360 pounds).”
VAS: “So, what if we can’t find a groin pulse to stick this needle next to?”
ME: “Then we make our best guess and go in blind. You’d better numb him up more.”
VAS: “Won’t we hit an artery if we go in blind?”
ME: “Maybe. You just hold pressure and move the needle one finger to the right. (And besides, he’s bleeding anyways, that’s why he needs this line).”
VAS: “What if we try and just can’t get the line in?”
ME: “We keep trying. Eventually we call the Cardiology fellow. If she’s busy, we call surgery. I hate calling surgery. Give him more anesthetic.”
[ … 11:08 PM … ] Went to the cafeteria to get a huge chocolate chip cookie. They always play ’60s Motown music at night down there. I like Motown music. It reminds me of ghosts from a happier time, especially around midnight when I’m the only person in the huge dining area. Today as I was leaving I heard,
“… There are some sad things known to man,
but not too much sadder than,
the tears of a clown,
when there’s no one around.”
It’s eerie how the lyrics always seem appropriate when I’m on call.
[ … near midnight … ] H.L. (my 4th year medstudent): “Hey Scott, the Cardiology fellow is going to a trauma in the ER! Can I go with her?”
ME: “Um … sure, go ahead.” (why is a cardiology fellow going to a trauma?)
H.L.: “Thanks!” (runs down hall)
ME: (to myself) “Traitor.”
Although my night is not over yet, this entry is. It’s long enough. And Amy’s still at that damn party. Good night.
