Jim walks up to the desk in the PICU, talking to O about S - S being the lady with a stroke that I keep mentioning, who's been trying to die. "She's got death rales, I don't give her more than 24 hours." O pauses. "Wait a second, I heard she'd already died."
She did, not half an hour after Jim went in to see her. One of those surreal moments this morning.
We've had a lot to laugh about in the last few days - the patient with night terrors who proved it by waking up the entire ED with his screaming in the middle of the night; the woman who can't help her horrible eczema that means she sheds all over her bed. She uses lotion. Jenny - "Not enough." Our chronic pain patients who get their morphine shots and then go outside to smoke - we had a patient on the service a while back, O Best Beloved, who blew up her face because she was smoking a cigarette while on oxygen for her COPD. The plastic surgeons had to piece her back together. And they say we get one a month or so of people like that.
We laugh because we cannot weep, as the saying goes. The things that frustrate us - my patient who has nausea and vomiting and diarrhea, but can't produce a stool sample; the unrepentantly morbidly obese patients who complain because they're tired all the time and can't breathe; the 16-year-old who overdosed on a cocktail of psych meds and 8 Tylenol after slitting one wrist (Why is he on our service? Psych should have him! Dr. K is livid); the people who want easy answers or don't care or don't want to hear - these things are enough to make one weep. So we find the humour and the absurdity and we lift it out.
We could put them both in the same room with one hamburger and let them fight it out. Seriously - we told him to lose weight, so now he's eating like fifteen salads a day, and his INR is stuck. Can we D/C salads? No, they're friends. Shot of morphine and a smoke break each.
We've had four patients now die on our service - one on the EP table, three DNR's - but we brought one back from the brink of death. He's got AIDS and he's homeless and once he leaves rehab nobody knows if he'll follow-up or if he'll just fade into the background and die despite our efforts.
Medicine is strange. So very, very strange.
On a personal events front, I got out at 1 yesterday, called the insurance people. We have an estimate. Go get your plate. So I went back down to see Michel-Ange for the last time, got my license plate and my single earring that I'd forgotten. Took the title to the State Farm office. Selling price for a 1987 Honda Accord with 247,000 miles on it is $968 or thereabouts. After all the adjustments were made (deductible, bonus money for not using the rental car, sales tax, etc) the State Farm lady gave me a check for $908.05 - significantly more than anyone thought I'd get for my car.
And they sent in the crash report for me, and if my crash gets investigated they'll take care of it. State Farm has been good to my family.
And I went back and spent the night at home with my Angel and still got my work done. It's a Sunday call weekend, and the weekend I gave myself to round Saturday, so I won't be home this weekend at all. Angel is coming down Saturday, maybe bringing company, to amuse me and keep me from staring into space all day, but it's going to be a long few days.
Monday marks the first day of my last week on service. That surprises me; I don't feel like I've spent hardly any time or learned nearly enough. I'll be in Fort Wayne next, O Best Beloved. An entire month at home. I can't wait.
And now I think I could use a nap. I've been up since 3 AM and I don't know if I'm going to be able to force myself to bed early. Until later.