And the alphabetic song meme...another time, maybe.
Thoughts and love to you, ishotkenney...I have your number stored in my cell, for future reference. Msg if you ever want to talk :)
And the meat of the entry:
Sent a call from Quin's parents to my voice mail last night. Had things to do, was in Do Not Traumatise mode. They're grownups, they'll cope. Went to bed at midnight. Tomorrow I will be having an Extremely Long day, so I will go to bed early tonight. Then, tomorrow, I will go pre-round on my patient at 7 AM, and then do work until about 4 PM. I will subsequently drive home to FW, where I will attempt to wrap up my campaign. Then I will turn around and drive back to Indy, planning to arrive between 2 and 4 AM. It's a little over 2 hours each way. I'll get up Saturday morning at 6 and pre-round at 7. I'll stay as long as they want me to stay, then come home to FW again. Because I miss my Angel that much.
I can stay until Sunday evening, when I come back here again, and spend the week doing work and pretending I know what's going on. I'm getting better at it. And then, assuming it wasn't so bad this time, I'll do the same next weekend. The other alternative is to take Saturday as my day off, and just go back on Saturday night to round on Sunday. I haven't decided.
What I have decided is that the new residents are pretty nice, especially JL. She's the only girl on the service, and is second in importance to JK, so when he's not around I report to her. Today was switch day - all the residents I was getting used to in the last few days sort of up and disappeared today, leaving us with a new group. I'll use nicknames. JL is known as "Stalker girl", as she has a psycho phone stalker who calls her in the middle of the night. R is "Flyer" for some unknown reason, and B is called "Lance," because Dr. M thinks he looks like Lance Armstrong. I spent most of the time I spent with anyone with JL, and we get along quite startlingly well. I like her. She showed me where to go to get my paper signed for my Special Wishard Computer Number (up to the mental health section, drug rehab wing) and offered me a ride to my car. A very cool woman.
This morning, then, everyone got the Introductory Talk. This morning, I presented all three of our current patients: the ingestion kid, the LP boy, and a new admission, 1.5 years old with a frightened 17-year-old mom. It's his first time in the hospital for his asthma. This morning, I looked him over but didn't get much of a history, as mom was asleepish and not very talkative. Got asked a number of questions I didn't know the answers to. Felt silly. Must learn about Asthma.
By the time I'd presented my three patients we were already discussing sending two of them home. The kid with the ingestion, after all was said and done, appears not to be in danger in his home. LP boy was feeling great yesterday, and as I was about to call Micro to get a 48-hour read on his CSF culture, JL showed up. "JH just called me. They paged him. D is enterovirus positive." Bingo. Called anyway. Cultures are negative. Got his discharge orders started, or someone did. It was all sort of mysterious.
Ran into Dr. M, who commented that my admit H&P on the ingestion kid was very nicely done. Sat down and wrote my notes - two SOAP notes from pre-rounds, one admit H&P for the new one. Scampered over to Riley for noon conference, on growth curves in children. Grabbed lunch - taco salads in Riley cafeteria are way too big.
Then the asthma kid was doing well, nebs to q4-5h instead of q3, and JL had me do the scut work regarding getting Mom set up for asthma education. She's working hard. Trying hard. My heart goes out to her. Got all of that done, finally, and found JK in the newborn wing. Ran a few errands for him, called in newborn appointments, M and I both did, something he calls "divide and conquer". It went fast.
And then we got the paperwork moving on the ingestion kid. JK sat down with me and walked me through doing a discharge summary on the computer, which is much easier than doing it on paper, half the work is done for you. And he commented on how nicely I typed, and how fast I caught on, and I felt pretty good about the whole thing. I think I can do the next one, no problem. Just one more thing to do, he says. It was 3:30. We've got a new kid in. Go ahead and go do an H&P on him and you can run the service tomorrow just like today.
It's nerve-wracking, knowing that you're the only person who's going to be presenting during rounds; that everyone's looking at you to find out what's going on with the patients. That's kind of a lot frightening. But Dr. M said I did very well. He pointed out the holes in my asthma presentation (Why am I so bad with asthma? I don't know. I need to remedy that.) but then said "Nobody ever gets everything in." I'm very much glad that I have Peds to work out my presenting and note-writing skills on before I have to do the high-pressure services.
I went down and did an physical exam on the new baby T. He came into the Urgent Visit Clinic with his fifteen-year-old parents (baby is seven weeks now) saying he was fussy and feverish. Standard labs. Shot of ceftriaxone. Follow up tomorrow. At follow-up, they had new results: the blood cultures that had been drawn were growing S. agalactae. The kid's septic, with a blood-borne bacterial infection. The reason this was so surprising is because he didn't look all that sick. So then they did the sepsis workup, which includes a lumbar puncture. I see so many of them... That was reassuring.
Now he's our baby, probably for the next few weeks, as we plan to do antibiotics out until a week after the first negative blood culture. He was asleep when I got there, parents somewhere else, so I sat down with the chart and got the history from it. Maybe they'll be there in the morning. As I was going in to see to the physical exam, the nurse pauses. "Don't you dare wake that baby up."
I smile. "I'll do my best, but I've got to do a PE." She knew and I knew that I had to do my job. She shook her finger at me, playfully. I think the nurses like me. And then I went in. Newborn or very young child, you always start the physical exam with the things you can't do with them crying. Heart and lungs, listen and listen. Heart rate regular, if fast like all babies, and a very nice soft murmur with each beat. It's probably a flow murmur - a normal thing in babies, especially sick ones. Lungs clear. Then I unwrapped the little creature (So tiny. They're amazing...) and squeezed his tummy, looking for bumps or lumps or big liver and spleen. If they're crying, it's impossible except between breaths. Percussed across it, listened to bowel sounds, undid his diaper and peeked to make sure he had all the right parts in all the right places. Wiggled his legs but didn't do the full Ortolani and Barlow manoeuvres, which check for developmental dysplasia of the hips. I should've. Oh, well. Played with his hands and his reflexes. Peeked up his nose, waited for a yawn and looked in his mouth, carefully lifted him and checked his fontanelle. And then I pinned him down very gently, and looked in his ears. And he never woke up completely. He opened his eyes a bit, long enough for me to shine a light in them. No crying, no fussing. The nurse was most impressed.
So JK and I wrote an admit note on the computer for him - I see how it's done now, I could do it again once I get my number, and that's when JL and I went away. All the way down to the (closed) Information Security office. Maybe I'll be able to find it again. I didn't leave until after 5, but I felt good about it.
Came home, heated up a cup of soup and had a sandwich. Am now waiting patiently for Angel to get back so I can see him before I go to bed. Perhaps I'll write more of Jen's story. Or fill out the question and answers. I should learn about asthma, but I don't want to. This weekend: expanded H&P. Figure out what the everloving fuck Evidence-based medicine is. Try and sleep.