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Nobody wears a white coat any more...
...a tribute to becoming a doctor.
Before I go to bed...
Just for freakachu420: The little boy with the croup and the psycho dad from hell, JG, was discharged on Friday evening. When we sent him home, he was breathing well, no noises or stridor at all, playful and happy. No reason to keep him here, not enough grounds to file a 310 without causing a lot of hassle, and he seemed fine...
At 4:00 on Saturday morning, Dr. M got a call from JK, the resident who was on that night. "Dr. M? This is JK. I've got a little boy here in the ER named JG with stridor..." Dr. M.: "And I said 'Is this a joke?' And I was waiting to hear 'Yes,' or 'He's been intubated', but JK just said very calmly, 'No, it's not a joke.'" And so JG came back in with his mom, spent the night, and went home on steroids. We told you he was sick.

I would update, but I can't remember what I've talked about, O Best Beloved. And it's getting very late very fast. So notes for later:

Came in yesterday and got assigned to a new asthma patient on the wards. Spent almost 40 minutes getting her incredibly complicated social history. Then forgot to get vitals before presenting. "You turned a home run into a double. Sad..."
My decision to order a second EEG on the ALTE kid was justified when it turned up left temporal spikes and slowing. Booyah!
Got scolded by JK for not telling him I was going to meet Angel for dinner, as he would have let me off hours earlier. Met Angel for dinner. Had a wonderful time.

Finished my expanded H&P, will post most likely for peer review later. Stayed up far too late for that.
Admitted children tonight after thinking I would get to go home early for lack of anything to do. Got home at 11:20 or so, despite promises from peds inpatient orientation that "evening call is no later than 10, and you'll get home earlier most nights."

Am going to sleep 5 hours tonight, maybe 6, after having gotten 4 the night before, and 5 the night before that. Call it residency training.

Medical Students: (will post to med_school community too) I am working with the student newspaper, and we think it would be fun to do an article or several about how other med schools do things. Anyone want to be a correspondant for me? :)

No call and no papers tomorrow night, I think I may sleep then, so as to be alert and enthusiastic for this weekend. I must study (I hope Blueprints comes in) as the exam is on next Friday. I can't believe this rotation is almost over. I'm terrified of Surgery. If I'd forgotten vitals in Surgery, I would've become the whipping post for everyone...

There's a lot more I wanted to say something about, like how the moon as I drove home was the clean-edged half-circle of a scalpel blade, poised luminous above the earth. About the transformation at birth from quiet, goo-covered infant to screaming ball of arms and legs. About looking up things with JL and the ER doctor with the blonde hair that I felt some strange draw to, briefly. About kids and monitors and croup and asthma and the mom who just never bothers to bring her baby in any more, until the 6-month checkup when the doctor called for an ambulance to admit. About AT, the sixteen-year-old who is bright and beautiful and going to wind up dead, burnt out, or pregnant. Horror.
But it's late, I'm tired, and I have to be back on the floors at 7 AM. Radiology rounds at 7:30, for our morning report. Dr. M. thinks I'm doing well, that I need to get a little more experience with organisation, but I'm well-read (since when?) and inspiring and energetic. You want to hear inspiring and energetic? I haven't had time for a shower since Saturday evening. Saturday evening. I don't care that I'll be sacrificing sleep; I need one. If I could've gotten my ass out of bed yesterday, I would've taken one then. This morning was a write-off; I'm lucky I got to school.
I'm also blessed by a tiny miracle that involved me deciding to throw the trash away in my car. And I looked at the sign next to the trash can and thought "That's funny. Why is there a key tied to the sign?" And then, my fatigue-befuddled brain said to me, "You know, that looks a lot like the yellow wrist bungee that was on the key to S's place that you lost at home somewhere. You don't suppose..." I did suppose, and I pulled out my new-minted spare key, and compared. It was. I guess I must've lost it in the parking lot.

Falling asleep at the keyboard. Rambling. Good night, O Best Beloved.

now feeling:: exhausted exhausted

3 whispers echo . o O ( ... ) O o . whisper a word
freakachu420 From: freakachu420 Date: September 17th, 2003 11:54 pm (UTC) (etched in stone)
My sweet beloved...

I don't blame you for ANYTHING regarding that sick child-- you aren't a doctor yet-- but did ANYONE think to call Social Services after the *second* time? God, wondering what is happening to that child makes me actually physically ill. Please tell me, by email if necessary, if something bad happens to him.... :(

...and the mom who just never bothers to bring her baby in any more, until the 6-month checkup when the doctor called for an ambulance to admit. Again, not your fault, but AGAIN, why isn't ANYONE calling social services?? That makes me so sad. So many children who could have chances at a better life, essentially told that they can't because their parents are so selfish.... -_-

And the opinions expressed here come from a mother of THREE who KNEW she could not care for her first two, so gave them up.

There is no excuse. And the doctors you study under should care more.

It is not you, my dear. It's just anger.
ayradyss From: ayradyss Date: September 18th, 2003 04:29 am (UTC) (etched in stone)
JG's mother when she came in the second time with him was a very different woman. Social work came and talked to her at length, and she consented pretty readily to having him stay as long as necessary, as well as to having pulmonology consult. And his primary MD was called to talk about the family. I don't know how that discussion went.
We had radiology go over the films for evidence of abuse. We talked to social work at length. When mom brought him back in the second time, our biggest fear was relieved - his family will seek medical attention if he gets sick, despite his father's threats.
As far as what brought him back in - what he has, apparently, is an atypical croup presentation - just like the kid we almost sent to R for intubation last night, who was sent home from the ER the day before. He was in no distress at all when they sent him home Friday, and they expected he would recover completely. ENT wants to scope him, because his X-rays show some subglottar narrowing, but they're going to do it as an outpatient rather than keep him in here.
If I understand the situation correctly, Mom's insurance kicked in early this week, so the financial burden is significantly eased.
The only charge we had to file on was neglect due to the father's threats not to pay for medicine, and with a child as healthy-appearing as he was, croup aside, there's very little chance that anything could have been made to stick. Especially not when he did come back in.

As far as the second mom...it'll make a little more sense when I tell the story; the 6-month-old child was seen several times in a week at the ER for her coughing and wheezing, and each time they sent the baby home on albuterol nebulizers and steroids. Mom decided that it must not be that serious, since the kid got sent home, and so whenever her baby has trouble she just goes back to doing the albuterol nebs like the ER told her to. She's of the opinion that her child sounded and looked much worse the two times she was sent home, and doesn't really understand what's so serious now.
And the kid, to her credit, is playful and active and looks well, just has a nasty cough and a lot of wheezing.
Sad as it is, this appears to be life at the Wiz. We're a hospital that has about a million visits a year and is running several tens of millions in the red. We see the poor and indigent, with a mission to serve everyone whether or not they can pay. Apparently, some doctors (like JG's) actually are under the impression that services here are free. They aren't, but in the end nobody pays as much as needs to be paid.

These two kids (well, except JG's dad; his mother is actually quite reasonable once the high emotions wore off, and very worried about her kid's health) are run of the mill for us. It's just life with the poor. Social Work will talk to the new baby's mom, and we'll have her round with us again, and we'll work something out.
ayradyss From: ayradyss Date: September 18th, 2003 06:37 am (UTC) (etched in stone)
I don't want my previous response to sound like we didn't think about calling CPS with the croup kid. We spent probably 20 minutes in discussion over whether we had something worth filing about - whether we really believed the kid's life was in danger.
We finally decided that despite having a lot of second-hand and "he said" evidence, we didn't have enough documentation to show justification for our concerns.
As the kid appeared well-cared-for except for this medical issue, we decided not to file, as the only thing we had grounds for was neglect. Nobody was really 100% certain about it, but it was the decision the team finally came to.

And the new kid from last night is not leaving until her mom understands her condition.
3 whispers echo . o O ( ... ) O o . whisper a word