“I don’t think I’m going to keep doing this,” an older colleague and partner for the evening shift says to me.
He’s the third person this year who has decided to opt out of the hospitalist thing here. There’s no need to ask why. It’s just a question of what’s next.
“You know, I used to enjoy seeing patients in the hospital,” his older Asian eyes sparkle, “I really liked the interaction with other docs and nurses. Talking in the halls about cases. Now I hardly see anyone. Everyone’s in a cubby hole typing on computers, hahaha.”
I’ll be sorry to see him go but it’s not a surprise. He has an office practice so he’d rather do that exclusively. At least in the office, you have some control, a fairly regular pace, I hear.
Here, as a hospitalist, you get pulled in every direction. Fielding calls about two other patients while you’re in the middle of this one. Weighing benefits versus risks versus worst case scenarios. Worrying about this. Stressing about that. Forgetting about something because the other things distracted you; I hope it wasn’t too important.
As for control, I wasn’t even supposed to be here tonight.
Eventually things get busy as usual. One or two or three patients awaiting your orders for admission to the hospital. Orders. We’re the generals. Nurses are the soldiers. I try to remind myself of this when I get deluged with well-meaning but ultimately pointless floor calls. It’s a war against Pestilence, the first horseman of the apocalypse, because we all know who the last horseman is.
Sometimes the ER docs call us with a soft admission, meaning someone who really doesn’t need to come into the hospital. When there isn’t one or two good reasons to hospitalize, there’s usually a laundry list of not-quite-problems from the ER physician’s report:
1) patient burped – rule out atypical heart attack,
2) mildy dehydrated (from sitting in the ER for six hours with nothing to drink),
3) dry cough and … out of tissues,
4) blood pressure went up (when we stuck her with a needle several times),
5) blood pressure went down (when we gave her narcotics for the pain from the needle jabs above),
6) patient farted something awful – rule out something died in there.
True diagnosis: They can’t get a hold of her family, it’s the end of the ER physician’s shift, and they need to get this lady the hell out of the ER already.
The new patients this night do need to be here. A young asthmatic with the wind whistling through her bronchioles. An old man with a big floppy heart carrying an ocean in his legs and lungs. A woman burning up with fever with zero immune system from the last resort chemotherapy she got. A representative mix of air, water, fire, respectively. (Gallstones would have been a good candidate for earth.) It’s elemental, my dear Watson.
Sometimes I ask about “resuscitation wishes… if your heart or breathing stopped, would you want… It’s just routine and we have to ask.” But if you’re under sixty and not a trainwreck, it’s not so routine nor do I ask typically. The fifties are still young in this milieu, but it’s also the decade when your body starts cashing any bad checks you wrote in your younger days.
Still, the hardest thing to say most times is “we can make you better.” It’s a promise, a guestimate, and a commitment. I don’t say that to everyone either. I can’t.
Two out of three tonight isn’t bad though.
