Five days of evening shift in the ER began today, the day after my wonderful Angel turned twenty-five. You may go and wish lakos a happy birthday if you like. I will be having a much better celebration for him when I am not feeling so low. It is not helped, O Best Beloved, by the upcoming schedule: Friday-Saturday-Sunday, 3 PM to midnight; Monday, 11 AM to 8 PM; Tuesday, a 7 AM conference plus 3 PM to midnight; Wednesday a day off in which it is almost pointless to go home because Thursday-Friday-Saturday-Sunday is 7 AM to 4 PM; Monday off; Tuesday 7 AM conference plus 3 PM to midnight again. Two weeks, two days off, both scheduled so that it is unlikely I will be able to go home. Except that you and I know, O Best Beloved, that if I can see to drive my car I will go home. I will see my Angel, because six hours of sleep with him beside me is a dozen without. I cannot wait for October.
Tonight was not so bad. The evening shift is, if nothing else, busy. 18 patients, all told, ranging from a six-year-old with a worried mom (patient is playful and interactive) to a scarlatinaform rash to a broken arm to insect bites (x1 year. Two dermatologists weren't sure what kind of bug was biting her son, how did she figure we were going to help?) to a bruised head (please keep your VCR on a stable TV stand when you have a toddler of 13 months; she will pull it down on herself if not) and a bruised hand (but he got a splint for it). And that was just the paediatric patients.
I triaged abdominal pain, explained to a 68-year-old man that while one might never forget how to ride a bicycle, one should probably not force the issue after falling off once or twice. Four times is definitely excessive, and X-rays were long in coming. I broke out the speech on anxiety attacks to a man who didn't understand why he was having them (answer: we don't know either). I comforted a 22-year-old G5P2 who was nineteen weeks pregnant, had had two previous miscarriages and two previous preterm labors, and had now fallen on the steps and was afraid she was going to lose her baby (fetal heart tones strong. Send her to see OB). I saw another woman who was ten days late for her period and had only now begun to wonder if she might be pregnant (yes) and if the two weeks of cramping was a bad sign (we don't know). My staff saw to the admitting of an elderly demented gentleman with a GI bleed, shortness of breath, and a hemoglobin of about half normal; to the triaging of a ninety-year-old lady whose belly hurt (bright eyes stared at me every time I walked by the room until she finally went upstairs); to the disposition of a man who was having fainting spells every time he stood up. I stitched the foot of a girl who swore she couldn't afford Bacitracin to put on it at dressing changes (one pack of cigarettes, honey, choose your priorities, nursing muttered at me) and whose laceration unfortunately went into the calloused skin at the bottom of her foot. Without an ankle block, O Best Beloved, adequate analgesia is difficult at best and impossible at worst in that spot; the skin is too thick and the patient too jumpy to risk my needle breaking off. I loaded her with 2 mL of subcutaneous Marcaine over the area. She didn't feel six of the eight stitches; she slept through the first three. She felt the fourth and the fifth (next time, I will go up to the well-numbed dorsum of the foot from my bisecting stitch rather than down to the plantar surface where she has been screaming at each prick, first) and whimpered through the next three while telling me she did not feel them at all. Her sister practically laid on her to pin her down. I will not repeat the words she uttered as I was trying to patch her together.
Did not see but discussed with the extern who was there - a likable fourth-year who wants to go into anaesthesiology and enjoyed discussing the mechanics of an ankle nerve block with me - the girl who was walking down the street, minding her own business, when some other girl she'd never seen before jumped out from behind a mailbox and beat her about the head with a stapler. Dangerous business, staff says sagely, concealing his ironic grin well, minding your own business. Let me guess, not pressing charges. People so very often choose not to press charges. Many times, they are the same ones who were "minding their own business" when a group of total strangers came upon them and set about beating them for no reason at all. It seems to save face somehow, if it turns our society into a sort of Clockwork Orange surreality at times. So very many people seem to be unfortunately assaulted while minding their own business over and over and over again, and never want the police to look into it.
We do not take the rape cases, not as students.
Discussed: the young man who had a half-dozen rum and cokes and then decided that taking his friend's prescription "sleeping pills" was a good way to relax. He was awake when I left the ER; ambulance crews woke him up along the way. Not my idea of a fun time.
And wrap-up from Tuesday: lip-stitching was complimented highly, including my clever use of a corner stitch to close a flap of skin, and at 0500 I was told to go ahead and get out of there, as I was unlikely to learn any more that night. 0500-0700 is remarkably quiet. You don't need to tell a medical student twice.
Speaking of telling twice, I have errands to run tomorrow, including making my way to the school to find out what my percentile ranking is for the last three years and finishing the revision of my personal statement, as well as trying again to get hold of the family doctor I worked with a year ago. It is 0200 and I am finally getting sleepy. Good night, O Best Beloved, and sleep well, when you do.