Another night on call
This is now my third call night - and the second with my current intern.
A few things have changed since my last call - we have a new attending, who everyone said was very hard-nosed and would chew you out for nothing. On the contrary, I have found her to be quite amiable and easy-going. This was a great relief, since our first day with this attending was after my second call. I was having palpitations at the thought of having to present all my patients to her from memory, since she does not like notes being used for presentations.
Anyway, aside from that big change, Ashleigh is now on my team. That means we are on call together - and also that we had Saturday off together. What did we do with our awesome time off? Well, we got rained on... a lot. It dumped about 6 inches of rain on us on Saturday, causing so much flooding it shut down many of the highways and flooded most of the major rivers in southeast Pennsylvania! The good news is that we left early enough in the morning that everything was not completely flooded and we got back just before they shut all the roads down.
We left at about 1130 to go to King of Prussia, Pennsylvania to their HUGE MONSTROUS mall. The mall is so big, it is two buildings!! Something like 400+ shops and restaurants are housed within this monstrous complex. It was freaking HUMONGOUS!! Other than that, I wasn't too impressed. I got to spend some time with Ashleigh, so that was nice, but I'm not a big mall person. Obviously, she is.
So, after my (almost) eventful day on Saturday, now it is Sunday (or by the time I'm done typing this, Monday) and I'm on call. So far, I've had one admission and one consult. The great thing about having Ashleigh on the team is that now we split the admissions :) That's ok - Ashleigh has only seen one consult and no admissions thus far. In fact, as I type this, she is asleep in the call room - hopefully for the rest of the night. I'm hoping we're done (knock on wood) for the evening.
The final BIG change that's happened in the past few days is that with the new attending came new rules. Since Ashleigh and I are 4th year medical students, we're now being treated more like interns - we are seeing our own patients (mostly) independently, writing their notes and their orders and having them co-signed by the intern. Our intern loves it, since he doesn't have to do much, aside from make sure we don't kill anyone :) Just kidding. I think we're doing pretty well for ourselves here.
Ok, I should probably go to bed soon, so I can be fresh and chipper in the morning for rounds bright and early.
Just as predicted...
Well, just as I predicted, that fellow I spoke about in my last post left AMA after he sobered up in the morning - and of course, after breakfast!!
I had call saturday, 10/1/05. It was a very long day. I got there at 0700, as is my usual custom. However, I am not used to being in the hospital all day long, all night long until the next morning.
The good thing was that we weren't that busy. We got 2 admissions, a transfer from the unit, and a consult or two. Not too bad. However, things move very slowly here. Maybe it's just me not being used to the system, but all the admissions took about twice as long as they should have - an admission for chest pain took 2 hours because as myself and the intern finished talking to the patient, the upper level came in and wanted to pretty much repeat everything we had already done. It didn't help that the patient was, how do I say, less than cooperative...
Let me share: This was a 48 year old homeless fellow that looked 80. He was picked up at a bar after complaining of chest pain. He had a history of a quadruple bypass surgery about one month ago at the other local hospital here in Bethlehem. He had been admitted here at St. Luke's 2 weeks ago with the same complaint (Chest pain and EtOH intoxication) and left against medical advice (AMA) 2 days into the admission. So, now he's back after being seen at that same other hospital 2 days ago and earlier tonight. The fun part of the story is that when he got to the ED, his blood alcohol level was 198. However, about 3 hours into his visit, he was caught with a mostly-empty bottle of vodka in his room and his blood alcohol level was 218.. pretty impressive, huh? He was also very belligerent, yelling profanities and telling us all to "stop wasting my fucking time!!" as he asked to go out and smoke.
Fortunately, we were able to convince him to stay (mainly by letting him go to sleep) and we admitted him with the full knowledge that after he 'slept it off' he would most likely sign out AMA again. Unfortunately, that is the way of the world - we have to admit them because should we not we would be at fault, but we can't make them take responsibility for their health. So someone like this guy gets to take advantage of the system for a warm bed and a night sleep with a couple of meals any time he feels because he says he has chest pain.
Our system needs an overhaul to prevent stuff like this happening. Ah, well. Such is life. Without people like this, medicine would be boring, right?