Doing well, I suppose. Working long hours on Medicine again. I'm taking a break to digest dinner after spending a hard few hours dodging bullets in the ER.
The most important part of the History and Physical on Staff Medicine is "Who is your primary doctor?" If they say nobody, and there are any medications at all listed on the ER admission sheet, ask "Where do you get your medicines?" It's strange how many people don't see a doctor but have medications. A little prying may save you a lot of work.
In this case, an unconscious patient and two teenage daughters revealed that she was "supposed to be on antidepressants, but she doesn't take them." Three phone calls and a little prompting later, I'm on the phone with a physician I know quite well, and he's sighing and telling me he'll be there soon.
I got the 19-year-old with pyelonephritis instead.
I'm working on an entry at home about difficult patients - I spent several days last week with two sickle cell patients in the hospital; one was belligerent and combative and demanded that she get her medication the way she wanted it while the other was sweet and passive and cooperated with everything we asked of her. My own visceral reaction to them, the nursing staff's response, and the way things panned out made for quite an exercise in introspection. It's taking some time to compose. I want to get it right.
In other news, my travel genes seem to have bred true. My mother called me from Newfoundland to tell me that she'd gotten reservations to the wrong city in the wrong province. All is well; flexibility determined that their vacation would be on course. But I was proud of her. No panic.
Valuable sleeping time is going into the composition of this entry - I'm sleeping far more than I usually do on Medicine months; from 2130 or 2200 to 0530 or so - and I'm still dead tired, exhausted all the time. And to boot, this call I'm on group call - I've taken phone calls from a patient with symptomatic gallstones (drink water and take some Advil, and quit eating hot dogs, they're gross), a possible pinkeye (see your local doc-in-the-box) and abdominal pain (probably nothing, but I sent her to be evaluated anyway). It's nerve-wracking in a way that's quite different from the way my first Medicine call was. I'm starting to grow up, so to speak. It feels good.
Interested parties will be glad to know that the addition of a little lemon juice to my bottled water fixed the problem I was having, at least for now.