December 14th, 2005

Modern Art

Silent night...

Slept almost 14 hours last night. It is a day off. I finished charts and did H&P dictations 72 hours overdue.

I have recovered something of my old strength, but not enough yet, O Best Beloved. The memories, I think, were never clear. I fall asleep on the dictaphone at 0300 when it has been a steady stream of admissions - seven in a night, one to the ICU. Four had last names beginning with "P"; three were GI bleeds, and I cannot even remember the rest of the diagnoses. Or perhaps I can.
Two calls ago:
Vomiting bright red blood; alcoholic; drunk on presentation.
One-week history of dark red stool and vomit; alcoholic; hemoglobin of 2.4 - barely enough to be alive. He survived. I was congratulated. I'm still not certain whether I deserved congratulations - I don't know that I did much at all except write the orders for blood transfusions and get scolded by GI for giving fluids to a man in liver failure with a blood pressure in the 60's systolic.
Heme-positive stools; kidney failure; anemia; severely overanticoagulated.
"Nervous" and took too much clonidine and Serax (a benzodiazepine).
Seizure disorder, noncompliant, seizing on presentation. Acutely delirious the next morning.
Acute stroke.
Group admission for deep venous thrombosis.
Med student L took call with me; he made it possible to survive by doing several of the admit H&P's for me, in essence. He hit all the right points and asked most of the right questions and then told me I was teaching him something. I hope I was; I don't always feel very smart. I try to teach - when I have a student with me, I try to remember my father's example and the good teachers I have had in the past. I have N firmly in mind when I have a med student with me, and the day we sat down and discussed ventilator management. Thus far, I have caught no-one rolling their eyes at me.

Last call, Saturday's call, I had six admissions including a woman I cannot cope at all well with; her medication list is some thirty meds long and she cannot give up any of them. Not to mention she's got chronic pain. It's all a nightmare. I don't know if I did the meds right when I wrote discharge papers last night either, but I trust in R to fill in the blanks. It was 2100 and I had to go home sometime.
I admitted a patient from clinic yesterday. At least I will not have any more clinics this week. Tomorrow is call; Friday is post-call. Everyone has asked me if I need time off for Grandpa's surgery. I do not. Angel will drive me in there when he gets off work on Friday and we will see him in recovery - what good would it do to pace outside the surgery? I would rather work. I have the weekend off.

I am a shadow of myself; I am empty and lost and I feel no joy, no pleasure in anything right now. I have brief crystalline memories - I was animated Friday night, late, after watching The Chronicles of Narnia with unexpected friends - but the days are days and the nights are too brief and I am dragged down, low, empty.
Medicine is almost over. OB next block, starting Monday; four weeks of every-third-day call and then back to Medicine for the third block of five this year. I never want to do it again. I can only hope it will get better - and I can only feel that I am complaining without justification when our medicine chief is rounding every day all day until 2100 and I am out by 1900 on clinic days, and earlier when I do not have clinic. I only hope I am doing my share.

A day of rest, O Best Beloved, and I am hoping that it will suffice me for the next few days. I am looking forward to OB. This weekend, I will tell you some stories.