Yesterday our ortho intern, Lindsay, came back from vacation, just in time to be on call with us for the first time. RB is doing medicine this month, too, and the two of them joked a little about how they don't remember anything about medicine. We had 9 patients in our service going into call, but Terrence pointed out that 9 wasn't too bad compared to other numbers. On a good note (sort of), Mr. Roboto was no longer "Mr. Roboto;" his movements were a lot more coordinated, the rigidity was gone, and he was able to go back to the prison after getting a bath. Hopefully the doctors there won't try to dope him up with Haldol again. Terrence also told Angela and me that we don't have to stay up past midnight b/c as far as he was concerned, we're almost fourth years and had nothing to prove to him. That's all nice to hear, but we know that Dr. L wants us to see 3 patients a night, and if we have to stay up past midnight to get those 3 in, so be it. I was paired with Sarah, and every time we had two patients to see, she gave me a choice between the two. I tried to choose cases that I hadn't seen before.
My first patient was a 21-year-old girl with a bad case of anemia (H&H 5/20), and while she didn't have a history of heavy periods, she did mention that her flow was lighter these last two months. Her MCV was 68, which seems like a clear-cut case of iron deficiency anemia, and Dr. L said to run some iron studies on her. Sounded simple enough. My 2nd patient came in with HTN and COPD exacerbation secondary to not taking meds for 3 months. Her story was sad; she's unable to work and raising two young grandchildren while their mother (her daughter) is in jail, and she can't afford her meds b/c she doesn't even have enough money to pay rent. She also has two thyroid nodules, but hasn't been able to get them biopsied b/c she can't find anyone to watch her grandkids for her while she gets the procedure done. Her other daughter works full-time and won't take them unless there's a real emergency (like now). *sigh* It's tough.
My third patient had a myriad of problems that I wasn't sure where to begin. She had a cervical epidural block done on her neck last Thursday for cervical radiculitis, and since then she's had HAs, LUQ pain, constipation, etc. On top of that, she claimed she had coughed up blood, so she got put on NPO status awaiting an EGD to see if she got an ulcer. Then she got mad b/c she was hungry and didn't understand why no one was giving her anything to eat. I read through her past records and found she was hospitalized at TSP for a Seroquel OD two years ago; that could explain why she was a hard patient to get history from. Angela and I both finished around 1:00, and I think that was the best sleep I had so far b/c I slept all the way until 5:00 w/o waking up.
As usual, Dr. L brought donuts for the team. In SSR, we offered some to the nurses, and when they declined, one patient said, "I'd like one!" He ended up getting two, and another patient walked over and asked if she could have a donut, too. Since it was hypocritical if she didn't, I went ahead and let her take her pick. Later, I opened the box again to get another donut, and the 2nd patient saw and asked if she could have another donut. "I don't think you can," I said, and she whined, "My nurse is right there. I'm hungry." The nurse looked up and I told him his patient wanted another donut. Beside me, Dr. L shook his head, and the nurse told the patient that the donuts were for nursing and staff. I don't think it got through to her; she's in the hospital for an unknown drug OD. Probably hungry b/c her stomach got pumped. But still...if I were a patient and saw doctors exchanging donuts amongst themselves, I wouldn't ask for one. Lesson learned: from now on, we have to be careful about where we eat our donuts.
Dr. L went over my last batch of H&Ps with me after he saw me wandering around the SSU shortly before I picked up my anemia patient; he said Mr. Roboto's H&P was perfect (yay!) and had only minimal critiques on the other two. Glad I'm doing ok =) I'm also grateful that he won't be going on vacation until after Angela and I leave; when he does, Dr. M (the more long-winded attending) will take over for him, and the interns are not looking forward to it. Dr. M is actually on vacation now so his team is happy to zip through the patients at lightning speed. I'm sure RB isn't complaining about that one =P
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