IM: First Night Call

After meeting up with friends (you know who you are) for dinner at Panera Bread, I drove back to the hospital for my first night call. There I met up with the night resident, Amie, and she told me that since it's my first call, she doesn't plan on working me too hard. "You have all of residency to do that," she said, and told me to go study until a new patient comes in. Sounded good to me, so I gave Keira (intern) my phone number and went upstairs to lie down/do questions. About 90 min later Amie knocked on my door (apparently the phone call didn't go through) to tell me I had a patient. This lady came to the ER b/c she'd had myoclonic seizures all day, then had a grand mal seizure as soon as she came to the ED. Oddly enough (or maybe not), she had a similar seizure last week in which several of her teeth got knocked out when she fell to the ground. This time she bit her tongue so hard it looked bruised and swollen on one side, and she complained of post-ictal dizziness. I wrote a detailed H&P on her and thought I did a pretty good job (Amie thought I did well, too), but it turned out my team would not be admitting her. She was a "bounceback" patient, meaning that she'd been seen in the ER in this same month for the same reason, and because of that, the team who took care of her last week will care for her now. Fortunately there was another patient available for me to see.

This second patient came in for a HA and knee pain secondary to a fall but when she got to the ED she was found to have a BP of 240/140. Yikes! Further questioning revealed that she'd been out of her HTN medications for 3 weeks, and that she had a history of being noncompliant with meds. She was given nifedipine in the ER and it began dropping her BP down to 170/90, at which point I retired to get some sleep before rounds at 6:30 a.m. The time: 1:40 a.m. Despite how "comfy" the room appeared, it was still too cold for my taste and I had trouble sleeping. Total hours of sleep, I'd estimate I got about 2-3 hrs. Then there was no time to get breakfast before rounds at 6:30, so I ate some cake from home and hurried down to the ER.

The attending, Dr. M, was nice, but had a somewhat brusque bedside manner. There were many times where he just left the patient's room without saying goodbye and it was up to Sherif (the third year) to say, "Let us know if you need anything" before leaving the room. He also likes to pimp, and the interns already warned us that if we don't know the answers, then he asks the interns, so it's best if we know the answers beforehand =P Today he asked us causes of pulsus paradoxus, and tomorrow I'm to tell him everything possible about jaundice. Oh boy...that's going to be a broad topic. We had a total of 13 patients today. It took about 2.5 hrs to round on all of them. One patient had attempted suicide and mentioned that he once stayed at TSH. "Where's Terrell?" Dr. M asked, and I was able to tell him where it was (sort of). On another floor, the chief medicine resident saw me, Annie, and Chris standing together and joked, "Man, what's with all the Asians here? It's like we're breeding like crazy" (he's Asian himself) He also offered Annie a free lunch coupon but not me or Chris; I had to wonder if it's b/c she's the only one on our team who was dressed up and not in scrubs (and therefore more presentable).

When we got back to the library, Annie and I were given the task of typing out our checkout list to give to Jacob's team (they're on call today). Using a sample list that Sherif left us and our own notes, we were able to compile a pretty good list with pertinent information; Sherif gave us an A for effort and commented that our predecessors (who'll remain nameless) had gotten an F on their first list because they'd had no clue what to do. I was pretty exhausted when I left the hospital at 12:30 but halfway home I realized I'd left a brand new CD that I got last weekend in the call room =( Fortunately Jacob found it and I'm hoping he'll store it in the cabinet for safekeeping until I can pick it up tomorrow.

Later I checked my email and was saddened to learn that Dr. Bailey from OB had passed away. He was the attending on call for at least two or three day shifts during my OB rotation, and he was infamous for not allowing the residents to use the Bovie during C-sections (though Dr. C has been known to bring out the Bovie once his back was turned). I was just telling the others about him yesterday at dinner, and now this happens =( Still, he'll be missed by many for sure.