I don't know the patient. All I know is that he was naked and outside and hyperglycaemic. "No, that's all the story. We don't know what happened. He doesn't remember."
I miss O, my resident at $county_hospital, calm and brilliant and organized. S is a good resident; he wants me to have a chance to get to know the system before becoming overwhelmed by patients. And he covers my patients as if they were his own. My patient, rather, as I had only one admission today from the shining new and modern Emergency Room at $hospital where I will be spending my next month. I am capped - no more than 2-3 admissions a day, no more than 5 or 6 patients at a time. I will be taking call with S; most nights, at least. He doesn't want me to take call with him on a Sunday, that's too much work, so I will have to find another time to take a call in order to make up my 5 required calls. Today, I took orders and made phone calls and suggested things. Today, I got a handful in my one patient, and we wonder if he'll be here in the morning.
C is a middle-aged gentleman with a long and complex history which we got in bits and pieces. He is, the nurses, suspect, still high on something. They begged me to have S implement the protocol for withdrawing patients before it became emergent. I did. It seems, O Best Beloved, that many months ago he shot himself in the leg with a nail gun. Although the nail was apparently embedded in the bone (the fracture showed up on CT scan, which I must look up), he pulled it out. After a couple weeks of daily dressing changes and neosporin, it still hurt but the hole had healed up. All this time he's buying Percocets and Vicodins from people he knows - no medical care at all - and he tells me he could get "a little" pus from the wound. He came in today, after nearly three months of pain, because he couldn't walk on his leg this morning. It's red and swollen and he's been having fevers and chills, and when I pounded on his back he jumped right at the costovertebral angle.
Ortho got called because that's what one does when one suspects osteomyelitis. They looked at the CT and the X-rays and said to put him on antibiotics and call ID (infectious diseases). I spent the rest of the day chasing this gentleman's life around. When he got to the floor, I had a long chat with him. Then I went and talked to Ortho. Then I came back and found out that he'd told the nurses he drank every couple of weeks, about a half-gallon of peppermint schnapps in a day when he did. Most recently, perhaps, yesterday. And he hasn't used heroin since he overdosed on Fentanyl and came to the hospital, but he's a weekend cocaine user. And he had a history of a positive TB test, without treatment. Oh, nursing says, It gets better.
He needed someone to fax to the county court that he'd been admitted to the hospital, because he was supposed to be in court this morning. Everyone, suddenly, got a knowing look. So quickly, his appearance after months of pain and suffering made sense. I'll call my resident.
I called S, who was in clinic, and went down to speak to him. He explained to me that he didn't want his name on a document that could cause him to be subpoenaed, and passed it off to Social Work. Then I went to work calling ID and Ortho to find out what we needed to do about the TB test and the antibiotics. Private room for respiratory isolation, sputum culture and stain for acid-fast bacilli, and why did you start Timentin and Clindamycin? That doesn't make any sense. ID staff calmed down once I explained I was the acting intern - and really only a 4th-year medicine student. World War II. I blame Hitler. He told me to get a bone biopsy and hold off on antibiotics. I told S. S said to continue antibiotics, but to call Ortho and let them know that a bone biopsy was recommended.
Nursing by now was laughing as soon as I walked up there, because they knew I was on my first day, and there was a general sense of pity for my poor beleaguered self. "You'll need a TB test." I needed one anyway. "How'd you get stuck with this guy?" Cellulitis. They said it was cellulitis, and I thought "Hey, cellulitis is interesting and easy." "Oh, S is your resident? I'll keep my mouth shut." S is nice. He's...thorough.
Thorough is a good word to describe S. A good PC word. He likes to explain. He likes to teach. But he does things to cover everything, and he orders them sometimes a little more urgently than necessary, and he wants to be very sure he's ruled everything out. So we had a stat CT and a stat Doppler leg (still not done) and Timentin and Clindamycin and Motrin for the swelling and the inflammation and get that CXR today and sure, you can add a urinalysis because of CVA tenderness. It's hard to convey the way he always seems to be rushing even when he's not, and the way it feels like he's going overboard in his thoroughness. He leaves behind him a swirl of flat faces, though, and I almost apologized for him a half-dozen times. But he gets results. Is that what matters?
When I am a resident, I want to be like O, like R, like L, to have time even when I don't have time, to focus on what has to get done rather than how many things have to get done. I don't want to be like S. He's very good. He's very smart, and I like him, and he likes to teach, and this month will not be a bad one. All those things are important.
He laughs, even at himself. His picture is up on $hospital's website, on an ad for the Internal Medicine residency, and he has his ankles crossed and his hands on his hips and he looks like he's in Riverdance, and when staff said he sort of looked gay in the picture, I said "No, more like Riverdance." Staff in clinic was hilarious, a jokester with a passion for doing the best for his patients. I overheard a conversation today that made me think; the resident had been accused by someone of committing fraud because she was seeking a reason to admit a gentleman to the hospital when his family wouldn't put him in a nursing home for the care he needed. Staff told her to do what was best for her patients, suggested some good reasons to admit the gentleman, and told her that if anyone said anything like that again that he'd write them up for slander. This same staff is the one who put into my hands a fresh photocopy of the website page with "S--------, star of Riverdance" written on it. S laughed, and then told me that I was taking all six calls and could forget my weekend days off (all Sundays except this one, when I get to see my butterfly finally). "Do I have to do a review on you at the end? You'd better take that comment back."
He's nice. I like him a lot. But he's so busy busy busy all the time time time. He's cynical and jaded, we all are, but there's more to it, and I can't put it into words. He lacks...an inner calm, perhaps, some sort of grounding. Maybe that's the problem, why I have followed him for one day and decided that he is not the doctor I want to be, despite his competence.
Perhaps, O Best Beloved, I understand more than I think I do.