Night Shift: The Nightmare Patient and More

Last night shift of the week! It started out rather slow; I did one H&P and had Dr. K look it over; he had lots of comments on how I could improve my H&P so that was good. Dr. B, on the other hand, makes us do H&Ps and barely even looks at them. I also saw Dr. G insert a balloon catheter into a woman's cervix b/c she wasn't dilating properly, and the patient was grateful b/c there had been two previous attempts that were unsuccessful. She was also glad that Dr. G took the time to explain what she was doing and what she (the patient) was feeling, which the other doctors had apparently failed to do. Tonight's attending, Dr. R, also works at the PCC and I may have to work with him next week. Either him or Dr. C, whom no one wants to work with because word is that he's not very student friendly and he pimps students to death. Later Anita and I got to watch Dr. K repack a woman's hysterectomy incision after she developed an infection. Now she has an open wound in her stomach and has to let it heal by second intention (repacking and keeping it clean) for a month. Wow. We also learned that when something is oozing pus, in the world of ob-gyn, the correct term to use is "purulent," NEVER "pus-sy." (You get the idea)

The "nightmare" patient in the title was a 22-year-old in her first trimester (accompanied by her prison-tattooed bf) who complained of abdominal pain radiating to her vagina, yet all lab tests showed nothing wrong with her except for anemia. It was noted in her history that she had been treated for abdominal pain at another hospital for similar symptoms but when the doctors found nothing wrong with her, she left against medical advice b/c "they weren't doing anything for her." The doctors and nurses were smelling either a malingerer or a druggie in search of some painkillers, but they didn't know what to do lest she accuse our hospital of "not caring for her" as well. In the middle of the discussion, there was a loud scream from the triage rooms (where she was staying), and everyone was all, "Oh, hell no, she did not just scream to get attention!!" Turns out the woman next door to her was going into labor (and that was the scream), so she was wheeled to L&D (labor and delivery) while Dr. K and I went to do a pelvic exam on our "nightmare" patient (I just watched). She certainly looked like she was in pain, but when I told Dr. K that, he shook his head and said, "Inexperience." (Meaning me) We looked at her cervical swab under the microscope, but saw nothing but epithelial cells. Dr. R's advice: give her some Vicodin and sent her home, but tell her to follow up with the doctor.

So we did that, and she didn't complain about getting the Vicodin, so we thought that was the end of it. Wrong. One of the triage nurses came back a few minutes later and said that the girl and her bf didn't want to leave b/c they had walked to the hospital, and would now have to walk back to wherever they live. The nurses didn't want to give her Vicodin if she was going to walk home, but on the other hand, the bf said that if the girl were to collapse while they were walking home, he'd call 9-1-1 immediately to bring her back and he'd "slap some dick" for putting her life at risk. First of all...what the hell does it mean to "slap some dick?" The nurses said he could slap his dick all he wanted, that was his problem, and we all got a good laugh out of that one. In the end, the nurses ended up calling them a cab using a cab voucher, so they did leave.

I got a chance to deliver a baby today, but Dr. K took over when he saw me hesitating about where to place my hands over the vagina to catch the baby. *sigh* I know the rule in ob-gyn is to be aggressive and get down and dirty, but I am not about to jump in and catch a baby without knowing exactly how to hold it and what to do, so sorry for being careful. Later we went with Dr. K to write post-partum notes, but because my knowledge of Spanish stunk, I had to see the same patient about three or four times (I saw her deliver a baby on my last shift) to ask her questions that I'd forgotten to ask the first time. So...must learn obgyn Spanish on this rotation or else. -_-

Still, my week of nights has come to an end. Now it's time to get used to getting to the hospital by 5:45 a.m. for daytime L&D. But next week, I'll be at the PCC for three days. Hopefully the profs will be merciful of my ignorance, but somehow I doubt it.