Feel sometimes like maybe I shouldn't say anything at all, as it all comes out offending someone or putting me in the wrong position. But even that sounds wrong to me. I'm not feeling sorry for myself, I'm frustrated at what seems to me to be a decline in my ability to say the right thing at the right time. It used to be something I was so very good at, they told me. And now...
Now I need to learn to relax - that's what's missing. I'm too used to having to be right.
Came in this morning at 0700, we were capped already. Two new patients for me to make three, but the nausea lady is going bloody well home. My side is hurting again; I think I'm unbalanced somehow because it's always the left and always a sharp muscular pain. Should take some more ibuprofen.
So my two new patients, one is terribly interesting and has pancreatitis secondary to a triglyceride (cholesterol) level something like 20x what the top end of normal is, but when her PCP sees her her triglycerides are under control. The other is a very nice old lady who has terrible oxygenation for some unknown reason. Both took forever this morning, since I waited around to try for an arterial stick on both. I got a stick with no results on the pancreatitis girl, and got RT to sign my procedure log anyway. I just want my procedure log full! Discovered to my dismay that a rectal exam I had previously done had disappeared. Will have to fill in with one I didn't get signed by S.
And then it was 1500 by the time I was done with everything. I'm starving now, thinking I should go get food.
My nausea and vomiting lady left, finally. She's been wandering around the hospital, going out to smoke, complaining that only IV phenergan works for her nausea but refusing to stay on the floor where she belongs. I want to take her seriously, but when all she does is bitch that we're trying to wean her off IV's it's hard to do. And when she doesn't act sick, it's hard to believe that she's dying of horrible nausea all the time.
If you're in the hospital, be sick. Get better and go home. Don't come here for your med fixes.
Jenny's patient down in detention passed one of the two razor blades he swallowed today. And a Pepsi tab. One to go. Psych recommendation: Keep patient away from sharp objects and things he can swallow.
Joe's patient is trying to die. A week ago he was trying to talk around his vent, because he can't draw pictures well or write at all, he being illiterate. Today his blood pressure is dipping below 50 despite being on 3 drugs to increase it. We watched him for a bit, heaving chest with the sudden inspiration-expiration of the vent, lying there with hands starting to swell. "I've seen people hang around in the 30's for hours," the PICU nurse says. "I hope he's done by six."
We're callous in our futility. Something happened yesterday or the night before, and he got a bowel obstruction and he swelled up and we couldn't do anything about it because you have to be able to treat something, not just an observation. He's on antibiotics and getting good care and we don't know what happened. But now, as A puts it, we're just looking busy. We're doing things because we want to give ourselves the illusion that we're doing things. His QRS complex is wide because his body can't perfuse its tissues any more, so he's going into lactic acidosis. We could give him bicarb, buffer that. The QRS would look better. It wouldn't really make a change in him except that his heart would go on working a little more nicely as the rest of him died.
Funny how it works.
Doing a chart biopsy today and found the following tidbit:
FAMILY HISTORY: The patient is deceased secondary to MI at age 72. One brother with MI at age 40. Sister with mitral stenosis and MI in her 30's.
The patient is deceased, eh? This was from an old admit history in the computer, on the lady we admitted today. I just laughed for a while. The assumption is the patient's mother or father is the deceased party.
Think I'm going to see about a bite to eat or something, before the cafeteria closes and I'm stuck eating from a vending machine like I did for lunch. Ham and cheese on Texas Toast, a bag of "munchie mix" - Doritos, Sun Chips, Pretzels and Chee-toh's all in the same bag. And half a Coke. I threw the rest away because I couldn't cope with the sugar. That and the idea of the migraine hiding in the rest of the bottle.
I feel like I should be complaining of a headache; I have the same sort of general malaise. But I don't have a headache. Instead, I have no textbook and thirteen hours before I have to do anything again. Why am I here?