I'm still a little teary over it.
Medicine service is slow so far; C capped her 7 admissions but she's the only one in ten days to do so. I had only 3 on my call night and slept from 00:30 to 05:45. I sent 3 further attempted admits to their appropriate physicians - the ER does not always remember to ask our most vital question: who's your doctor? When there is one, and he or she has admitting privileges, then we do not admit the patient as a staff patient. We admit as a private, if the physician wants us to - they come in, see the patient, staff with us; those are the ones who have something interesting going on with them, most of the time. But these patients were not interesting at all - one gentleman with sickle cell disease who was angry with the entire world; one poor lady needing ECF placement due to two broken arms and living with her 60-year-old daugher; one abdominal pain admit rule-out MI with proven Barrett's esophagus and not on her obligatory proton pump inhibitors who didn't need to be freaking admitted in the first place - but I digress.
I admitted three relatively interesting patients: one 20-something gentleman who tried to kill himself with methylphenidate (Metadate CD), lisinopril, and Celexa (of the three, only Celexa might actually kill one); one GI bleeder with a hemoglobin of 6.5 and a history of perforated ulcers; one dump from Neurosurgery - transfer in from outside institution due to a head bleed and consequent need for observation in tertiary care center, youngish, in his 50's. Medicine service to admit secondary to Neurosurg not wanting to come in late at night and actually see a stable patient. Neurosurgery to do all the ordering around; us to do H&P and discharge paperwork. Not fair. But there are some doctors that you don't argue with. I told my chief about it; my chief heard who was dumping it on us and sighed. "Find a reason for us to be responsible. We'll mention it to faculty."
Staff the next morning was irritated, made noise. That's inappropriate. Tell me about it. But I have to work here for the next 2.5 years, and I'm not going to fight with a neurosurgeon. They're nice to me thus far.
He has a head bleed likely secondary to a brain tumor; he has a lump on his jaw that might be a parotid gland tumor; he has negative abdomen and pelvis CT scans but something is wrong with this man and fortunately he already had a physician appointment scheduled to investigate the mass so I don't have to deal with the burden of hello-nice-to-meet-you-you're-going-to-d
GI bleeder went home, stable, very anxious secondary to me discontinuing his chronic Ultracet. Look it up - FDA approval for 5 days max of use, not 6-7 weeks. I mentioned that when I called his primary (who does not admit with us). He may put the man right back on it, but at least I'm not party to potentially worsening a tenuous abdominal state. I sent him with a proton pump inhibitor and strict instructions not to smoke or drink. Then I did dictations and charts - I am chronically behind on both.
On the other hand, yesterday before clinic I did my last of 5 circumcisions; I am signed off on them now and may proctor or perform alone as I choose. I love procedures. I tapped a knee joint the other day as well, with much approval from the med chief who helped me. My confidence is beginning to grow.
This is the third of four call months in a row. There is a sign in chalk pen on the bathroom mirror: 24 Days, it says today. Twenty-four more days until Peds. And then after Peds my CME time has been approved - I will be making reservations for a conference in Kauai, HI for 5 days if all goes smoothly. My mother the amateur travel agent found a hotel 0.4 miles from the conference hotel that costs half as much, making it entirely possible that we might be able to get reimbursed for a small portion of the ridiculous amount of money it's going to cost to get out there.
It is busy; I am drained. These days of medicine are the most relaxing I have had in recent memory, and tomorrow will be a day off. I intend to sleep.