General Surgery: Shortstaffed at the Clinic

JB had to fly out of town yesterday because his dad was ill, so it was just BB, BR, RB, and me today. Normally on Clinic Days, we try to finish rounding by 8:00 a.m., grab breakfast at the cafeteria, and then go to clinic. I left RB on the 5th floor (where I had to recall some OB Spanish to interview a patient recovering from appendicitis) to get breakfast at 8:15, but no one else was there. So I went to the clinic at 8:30, but still, no one was there. But... there were five patients in rooms waiting to be seen, with the first room labeled 7:50! I've always hated making patients wait, so I paged RB asking if I can go ahead and start seeing patients. He got the OK from BB (now the most senior member of our team), so I went to work. The first two were lap chole followups (very straightforward), but the third was a man who needed an ileostomy reversed, and that required a physician's signature on the consent form. Fortunately by the time I finished talking to him the rest of the gang had arrived, and that made my job slightly easier.

Even still, RB was assigned to work with the neurosurgeon today, leaving BR, BB, and me to handle the general surgery cases. I never saw so many patients in one setting on my own as I did today. I had several lap chole follow-ups and also had to schedule new cases. One was an HIV+ man with rectal warts; when I presented to BR, the first question he asked was if he was HIV +. "One guy came to the ER once and asked how he got rectal warts," said BR. "Want to know what the attending told him? 'Buttf***ing.' " That's bluntness for you. What struck me as funny was that he chose to schedule his surgery for Valentine's Day, hardly romantic. The saddest case was one of our last patients, a middle-aged man with Stage IV adenocarcinoma of the lung whose vocal cords have become paralyzed. He needed a PEG tube inserted b/c he can no longer swallow and needs a trache to breathe. Any communication had to be written by hand on a notepad, and he wrote a lot about how his trache gets plugged up by mucus and his entire chest and abdominal area hurt from coughing and choking so much. It took a while for BB to assure him that the PEG will do wonders for his nutrition (the man was pretty emaciated) and pain control, since he can no longer swallow pain pills. The last case was a lipoma removal, but by the time we left the clinic, it was almost 3:00 pm.

I'm so glad I have tomorrow off...