The VIP Patient

Vacation's over, and I've started another month of floors at "the Bing," the suburban community hospital where we rotate 2-3 times a year. The last time I did a floor month there was back in October, so it took a while for me to remember my password and the way things worked in this hospital. Right away, I got a list of 12 patients, among which was the father-in-law of one of the PGY3's in the medicine program. We were told that he was a "VIP" patient, and to treat him well. To be sure, he was more intelligent than most of the patients I've seen, almost to a fault.

One thing for certain: he didn't make things easy for us. He was a noncompliant diabetic who had already lost a toe to amputation, and when I saw him both legs were bandaged up due to ulcers. "They told me to keep it wrapped up and that once it starts to smell, it's really serious," he said, then added that he never smelled anything bad from his foot ulcers. The wound care nurse who later saw him begged to differ; she called to tell me his ulcers were oozing and the stench was foul. We were hoping to discharge him later today but he needed home care and case management wasn't called in time to set it up, so my resident had to break the news to him that he had to stay in the hospital an extra night.

Needless to say the patient was pissed. When I first saw him in the morning, he was respectful and in good spirits ("Have you met my daughter-in-law?"), but when he heard he had to stay an extra night at the hospital, he demanded to leave and even wanted to drive home (never mind that he was admitted secondary to a fall --> fx and his driving would be dangerous to both himself and others on the road) My resident even called his classmate (the patient's daughter-in-law) to see if she could talk him into staying at the hospital, but that only made him angrier. "That wasn't fair," he told my resident, and I can't say I blame the guy. It was only when the nurse said the patient's insurance may not cover his admission if he leaves AMA that the patient said he'd think about staying. I have no idea at this time whether he's still at the hospital or gone, but hopefully he'll stay until at least someone picks him up to take him home.

Home Again

That's right...I'm back in TX and couldn't be happier. My last week of night float was miserable because I got a pretty bad cold (the congestion and sinus headaches sucked) and was living off Dayquil to get through my shifts in one piece. Now that I'm home, I can sleep as late as I want to take the time I need to rest and recover, something I definitely need. My parents are glad to have me home, and I learned just how spoiled Pearl has become in my absence. For the past few months my parents have been buying more expensive multigrain wheat bread from Whole Foods instead of the usual Oroweat Health Nut bread we've purchased faithfully all of Pearl's life (which she loved to eat). And since Pearl's still a bread lover, they've been feeding her Whole Foods bread, and now she won't accept anything else. I tried to feed her some Oroweat bread that I'd brought home with me, and she wouldn't even look at it. *sigh* My rabbit has always been a food snob, but this is taking it to a whole new level.

I drove past TCOM today to check out the changes that have happened since we graduated. The new building across the street is well underway and looks impressive; I'll have to take a picture sometime. Our Class of 2009 poster is also up on the "Wall of Fame," and as I looked through it, I couldn't believe the mistakes I saw on there. Jerry was on there twice under two last names. Liza's face was over Carisa's name. One of the Liu's had her name spelled "Lui." Pretty bad, considering this poster is going to be up for all future generations of TCOMers to see (not that they'd know the difference anyway but still). Wonder if there's anyone I can contact about this.

Night Float Week 1 Recap

At this hospital, night float is done in 2 week blocks. 5 pm - 7 am on weekdays, 6 pm to 8 pm on weekends. Six days on, one day off. And of course, when working 14 hrs a day, my routine was to wake up at 3-3:30 pm (depending on whether I make dinner to bring to the hospital), leave the apartment by 4:30 pm to make it to work on time, work my shift, get home around 7:30 am, then shower and surf the internet for about 30 minutes before going to bed before 8:30 am.

There are two night floats: one covering the heme-onc/nephro/university medicine patients, and one covering the cardiac/GI/private medicine patients. I currently have the first, which is universally dreaded by all interns because it covers more patients and the patients tend to be sicker. On average, my night float partner does get fewer pages during the night than I do, but when cardiac patients do get sick, they go downhill FAST. There have been times where I've been able to sit in the lounge and take pages as they come while she was gone trying to keep patients from bleeding out. That's not to say I've never had emergencies; last night one of the patients I was covering had a rapid response called for suspected aspiration PNA and had to be intubated and sent to the MICU. The room was full but I got to attempt an ABG (didn't work; the guy's pulse was weak and even though I hit the artery, the blood didn't flow in) and later called and met with his family. Fortunately things died down after midnight somewhat.

I have to say, though, despite my pager beeping constantly during the night, night float hasn't been totally bad. There were only a few times where I got truly overwhelmed, but I've learned to prioritize nurses' calls pretty well. And after midnight, the pages are more sporadic; I've gone 1.5 hrs at a stretch without a single page. Luckily for me, every night there is an overnight intern who covers their own team (there are 8 teams and I cover 7 at a time), and sometimes the team being covered affects my own night. There was one team in particular with a lazy resident-intern duo who always gave me the worst signouts (claims of "nothing to do" and ending up with me running around during the night b/c their patients had problems that weren't addressed during the day), so when that intern was overnight I took great pleasure in sitting back while he got paged every hour and never really got a chance to sleep (easiest night ever for me). After that, signouts from his team were much better.

There's a pretty good camaraderie among the interns and residents working overnight; we sometimes order dinner at 8-9 pm if there's enough orders for a delivery. If there are lots of admissions, the overnight residents are rarely seen during the night, but on slow nights, the residents and interns gather in the lounge and chat, which is usually a pretty fun experience. Sometimes any medicine interns/residents working the 11pm-7am shift will sneak out of the ER and come upstairs to eat and chat for 10-20 minutes (a luxury I didn't have during my ER rotation since it was my first rotation and I, being new, didn't dare to leave the ER).

I was actually surprised by how fast this week passed by, and now I finally get a day and a half off to myself. I'm going home for vacation as soon as my last shift ends, so soon I'll be back in TX =) Can't wait!

Goodbye, Wards. Hello, Night Float.

My last month of wards was probably the most laid-back service ever. My census never went above 8; for a while we only had 2 patients at a time. This was great for my resident and me, but bad for the two med students and PA student who were working with us. We were also hit by 2 snowstorms in the span of one week, which was ridiculous and unusual for this state. Fortunately the "snow days" were treated like weekends and only one member of each team had to work. And since I was post-call just before the snowstorm hit, I got 2 days off from work because of the way the schedule worked out. Great for me, and also good that my resident lived across the street from the hospital and didn't have to fight snow to get to work like others did. Some people ended up just spending the night at the hospital rather than try to drive home. Even though the snow was a huge pain, I have to admit that the following day, when the sun is out and all the neighbors are out shoveling their cars free from the snow, there's a strange sort of peace in the air.

My last day of medicine wards, I was on call until 8 pm and had to attend to a rapid response at 7 pm. A patient I was covering suddenly became dyspneic and had audible stridor. The nurses kept asking me what to do, and I just about froze. It's somewhat pathetic that I'm almost 3/4 through my intern year (and did a month of MICU, too) and didn't know what to do in that situation. So I did what was most logical: call the MICU resident and one of the triage residents to come assess the patient and see if she needed to be transferred to the unit. Fortunately she eventually stabilized, but definitely gave us all a scare. When I voiced my concerns that I would not be ready for night float (which I start this evening), the residents said, "That's how you learn." They also assured me I did the right thing by calling them for help when I was in over my head, but I can't help but worried that this will happen again on night float. I'll be covering the general medicine, heme-onc and renal patients, and everyone knows the heme-onc and renal patients are SICK. *sigh* I'm doomed.