Today I sang my way across the street, and I am on call today.
One admission so far, six potentials drifting in the phantom wind. One four hundred pound histrionic lady with a long history on our staff medicine service, here because her one-month prescriptions from her last admission have run out and she swears that my darling colleague never told her she should follow up with him.
Liar. It's on the paper she signed. The nurses read it to the patients before they go.
But that's par for the course for this woman; she chased her roommate out of the room in tears within fifteen minutes on the floor, she demanded that "That doctor didn't put me on no diet, did she? I gotta eat, them steroids make me." (I did, but only a cardiac one), she is rude and brutal with the nurses - she's called them old, incompetent, and told them they should retire - and that's just on the admission questionnaire - and on a prior admission she was moved from the floor after threatening a nurse. K says R says that she killed someone once, stabbed them in the back, and R knows these things if anyone does.
She's rude and she's mean and she's noncompliant and if I didn't feel an ethical obligation to at least treat everyone fairly (I am fast discovering that some people you just can't like, no matter how hard you try, but at least I can be fair and kind) I would tell her she can take her overbearing, demanding, rude and abusive four-hundred-pound self out the door and come back when she's learned how to act like a human being.
But she has a history of pulmonary embolisms and she's not therapeutic on her INR because she hasn't taken her Coumadin in a week because she was out and the ER doc tried to send her home anyway but she told him she felt awful and she'd come right back if he did. So he called me, snide and catty like ER docs are (he likes me, I think; he talks a lot) and told me about her. Did he ever tell me about her. Sometimes, ER doctors make me laugh. I needed a laugh before dealing with her; it lightened the mood.
I am now practicing benign neglect. I have checked in with the nurses and the labs and the CT of her chest (no PE) and I have done everything but physically round on her a second time, something I generally do when I go to put the H&P on the chart. I will not go in there; it will incite her to still further demands. She was furious enough that she had to be clear liquids only for an hour for the CT. She wanted her doctor to know about it and order that she could eat. Not bloody likely.
The rest of my day has gone smoothly: two patients out the door, two discharge summaries dictated. Progressively, my patient with alcoholic dementia has become more demented; I spent some time this morning talking to him while he conversed with me, his watch, and an invisible friend or two. He doesn't need medical treatment, though. He needs his family and 24-hour supervision and they chose a nursing home that I, fortunately or not, am not following patients at. So I waved goodbye to him this morning and thanked the social worker, who has been tirelessly striving to carry out orders passed down to me from my staff: send him home before he gets sick.
Alcoholic with seizures who went to ICU with frontal lobe contusions five days ago went to the homeless center today; his mother won't take him back again and I don't blame her; he's almost half a century old and has nothing better to do with his time than drink, smoke crack, and freeload off his family. They love him. They don't want to enable him. Tough love. I told his mother that we would do the best we could to put him somewhere safe, and social work (I love social workers) found him an inpatient bed at the rehab unit at the homeless center. Perfect. He's walking and talking and doing everything his bullheaded way, even.
And my forty-day stay I discharged and who came promptly back with a recurrence of pancreatitis is pleasant, requiring less drugs, and GI is helping from the outset now. I hope we can fix him. I want him not to be in the hospital; he doesn't have the money to pay his bills and someone is going to wind up eating the cost. I want him to have a chance to prove to me that he can stay dry, clean, and make something of himself. He's not too old.
Got the address of my patient who died in Hospice. I will send a card to his wife; she was a tiny fragile thing who, I think, may just melt away now that her all-consuming work has disappeared. Signed the death certificate, feeling sort of official at it. Also dictated his discharge summary.
It is nearly nine. I had best sleep soon, O Best Beloved, or who knows when I will get to sleep again?