Call rooms are on the second floor. Call rooms are always on the second floor, it seems. It's strange. The sky outside is a dull and sullen grey, threatening, overbearing. I have missed the sunset, sometime in the rush of ER call (chest pain, rule-out MI) and grabbing a bite to eat (grill, pasta bar, salad bar, takeyourpick) the sun has set and left behind white streetlamps reflecting off of grey roofs into a grey and featureless sky.
One patient admit of three potential. The gentleman with the osteomyelitis got his bone biopsy today, asked for Percocet instead of morphine, and is listening to my instructions. His fiance asked me if I'd taken classes in bedside manners, because mine was wonderful. He's marginally compliant with diet restrictions, has only smoked in his restroom once, and is generally making a rat of himself. But I am so very glad to be seeing patients, O Best Beloved, I really do like him. It feels good.
Admit is an overnighter, a woman with a long list of risk factors for a heart attack - she smokes, she has hypertension, she has bad lipids, she has diabetes, she has a history of heart problems, her brother died young of heart troubles...and she's here with an episode of chest pain, nausea, and diaphoresis (sweating). It's reproducible pain - when you push on her chest, at the sternum, she jumps. "Yeah, just like that." So many risk factors. We can't in good conscience say it's costochondritis, no matter how much we want to. I told her she needed to quit smoking. She gave me the "uh-huh". This woman, neck enveloped in head-width fat folds, forty-five pack-years of cigarettes, breast cancer survivor and diabetic (draw a hemoglobin A1c in the morning to find out if this 300 blood glucose is an aberration - I bet not), this woman is going to die of her malconcern for her body, sooner or later.
We laughed, we did, and I told her what kind of things she was risking by smoking. I didn't tell her what kind of things all the other abuse she was heaping on herself meant for her. I didn't have time, not even going back after the initial interview (so short!) to double check with her.
You know, she says to me, speaking of S, he's so hard to understand. Am I staying here at the hospital?
Am I staying here? It was a clarion moment, O Best Beloved, a vindication of the urge that had brought me back into that crowded little ER cubicle. I took my time, explained to her that she was staying for observation, told her why, told her what the plan was and what we'd be doing. I asked her, twice, if she had any other questions. She smiled at me (patient has poor dentition, the phrase ran systematically through my mind, that observer that will never be completely silent) and thanked me, said no.
S and J just walked down the hall - probably another admission, our second tonight of a potential 13 - and stopped off to ask me if I was going to spend all day and all night on the computer. I'm thinking I should do some reading up on chest pain, so I can sound smart in the morning.
It is black out, now, night as flat and featureless as the clouded evening had been. Arc lamps bleach the branches of trees, to my right the TV continues political inanity and horror tales of war, the screen in front of me holds its appeal only because on the other end of an ephemeral stream of electrons my Angel is giving up his evening to keep me company. Perhaps, O Best Beloved, I should free him as well and go back to my room.
Call nights, when slow, are so very very long. When busy, they are all too short.