Behind the White Coat

Welcome Wards

My last day of night float, and I got screwed in having to work Sunday night as my last day -- oh so painful. Last night was probably the craziest day I've had during my 2 weeks of night float.  Patients crashing left and right, transferring patients to the ICU, all kinds of oozing bloody pus filled decubs and meanwhile running around trying to convince myself I knew what the hell I was doing.  But it all worked out.  So I think at least.

So.. instead of giving me the day off, I was told to come in to Weiler hospital for my first day of the inpatient medicine floors.  Of course the intern I picked up the board from was overnight and had 5 new admissions.  I worked 5pm to 7am, and then had to haul my ass to the other hospital and got out around 2pm somehow surviving the drive home.  I would have signed out and left around noon if I didn't get thrown with these brand new admissions!  I had to even discharge 2 of the patients.  Brutal.  Now I can finally get my ass to sleep....

So begins the wards....

Night Float

So I am on week 2 of night float now.  My hours are pretty much 530pm to about 730am.  Ouch. Plus travel time, so I pretty much go to work, come home, and sleep. That's my life.  Thank god I get Friday and Saturday night off, which validates me to go out and stay up all night into the morning to maintain my schedule.  Which I certainly took advantage of.

Night float is kind of scary because it is just two of us interns covering all of the patients on Klau Pavillion, which probably means maybe like 50-60 patients each sometimes.  And you are the ones making the decisions for the most part.  Dizziness? Chest Pain? Massive amounts of bright red blood per rectum (BRPR)?  I actually saw the latter today.  Crazy weird lookin 40 yr ole disheveled black dude ex-IV drug user with missing teeth who looked like an older, smaller, cracked out version of Andre 2000.  A bedpan full of blood and hes feeling all dizzy.  It was disgusting.  Can you say 2 large bore IVs and a type-and-screen? (sorry that was one for the med nerds).  But most of the work is scut.  You put in a lot of IVs, draw a lot of bloods, renew meds, maybe if you're luck a lumbar puncture or a central line.. But you do learn a lot and learn to become independant.

Today though I really fucked up.  Amidst a slew of chaos and work to do, this crazy old man, another guy on methadone (for his ex-heroine addiction), here for some bad cellulitis on his foot, who also happens to be psychotic and was deemed unfit to sign out AMA (against medical advice) by psychiatry.  But of course when he said he wanted to leave I missed it on the sign-out (my fault) and let him sign out.  So I basically let a crazy man into society.  The team found out this morning and man they were pissed, good thing I didn't have to face the attending!  I sent an email to the chiefs and firm leader apologizing, though I wonder how bad this is.  I guess I'll find out when I wake up and go to work this evening.  On the bright side, at least i didn't kill anyone yet.

Sewing Tongues

So my last day of ER was Friday (for now at least), and I got to at least do some fun stuff.  One lady came in, about 38, with a history of pulmonary embolism, taking coumadin (a blood thinner, that stops blood from clotting), who had bit her tongue while chewing gum.  Sure enough the cut would not clot, so she had blood pouring and oozing out of this lil 1cm cut underneath her tongue, and she's sittin there soaking up bloody gauzes like there's no tomorrow.  Normally a cut in the tongue you would leave, and it would clot and heal up on its own, but in her case, the bleeding aint stopping.  We also couldn't just reverse her coumadin, since she could throw another clot into her lung (pulmonary embolism), So me and Farz, my ortho-to-be buddy, wheel her to the back and get out the suturing kit.  Some lidocaine with epinephrine helped anesthesize and slow the bleed, and we alternated holding the tongue up and throwing in some resorbable 6-0 vicryl sutures.  That's right, we sewed up her tongue!  The first few were difficult (none of us had sewed a tongue before, so it was a trial and error thing), and they kept rippin the lil tongue tissue it went through, so we finally got in some nice deep ones, and the bleeding came under control.  Of coures she has 3 sutures in her tongue, that can't be comfortable, but we had succeeded.  Quite fun I gotta say.

I had my fantasy football draft yesterday.  A tad early yes, and I did almost zero research. For $100 entry fee, lets hope i get lucky.  My top pick was Daunte Culpepper, and number two was Rudi Johnson in our 10 person league.  Lets see how it goes...

Now I start night float... 530pm to 730am for the next weeks. This is going to suck. At least I get Fri nite and Sat nite off I suppose.. Ah well, let the games begin.

ER Patients

It's been a hectic week of 12 hour ER shifts, I did 3 back to back 7a-7p ER shifts. Those 12 hours shifts seriously tire you out! In the ER there are always eyes watching you... The patients, nurses, attendings, everyone knows your move. If you make eye contact with a patient, or worse their worried family member, you are caught and cannot evade their piercing questions, which is part of the job of course, but ineveitably happens in the midst of chaos.

So I had some interesting patients this past week, especially my drunken Puerto Rican who was found passed out on the sidewalk with AOB (alcohol on breath). I went to see him in the "observation" room (pretty much a drunk tank--a room with white walls, no windows, and one big door, guarded by security) standard procedure for alcohol detox patients. He was this disheveled looking guy with a cut on his head and the "banana bag" running in his IV (kind of like a vitamin water for drunks). "So whats going on sir? What happened?" I ask. He looks at me and breaks down into tears, "I hate my wife, wahhhhhhh!!!! I hate my wife, wahhhhh!!" Despite feeling sorry for him somewhat, it was one of the funniest moments I've had thus far. A screaming, whining old drunken Puerto Rican guy. "And she hates me.. Wahhh.. I dont want to live, I hate her! I hate her!" ... So I ask him, "Sir why do you hate your wife??" .. “Because she’s black!! Wahhhh!” Good lord. I had to run out of the room because I couldn’t hold my laughter. He was alternating between a pathetic drunken cry, shaking his legs and all, and a sinister laugh. Alcohol level of about 550 I think. Gotta love the drunks.

ER shifts are hit or miss, they can be super busy but fun and fly by, but some days are slow but drag on forever. Like today for example, my first patient was a deaf mute. Do you have any idea how hard it is to triage and take a history from a deaf mute? Especially one who when you write on a piece of paper asking:  “So when did the dizziness start?” Responds with simply, “Chair.” I didn’t bother asking, so we had to set up the little video monitor with the sign language interpereter. What a hassle. Don’t even ask how we later got consent for the Cat scan.