Full house
I survived night one of seven as the pediatric admitting resident on 4A. Thank FUCK I have an awesome acting intern (AI) that takes call with me. I felt bad scutting her out to do post-op checks as the night went on but she handled it like a pro. I'd worked with Becca in the peds ER before and I know from previous experience that she's got her shit together and JFDI's (just fucking does it). I have another AI, Beth, who's the daughter of the peds cardiothoracic NP that we work with a lot. She too kicks a fair amount of ass. Ramzi left me one of the best bunches of med students I've had in a while - they know their patients backwards/forwards/up/down and show up ready to work. I know that a couple of them want to go into psych but from the way they work and act, you'd think they're budding pediatricians.
I only had four admissions the whole day: pneumonia, broken arm, viral syndrome (a totally fucking soft call in my opinion), and a sickle cell crisis. Not bad. It could have been much worse. Had I needed to admit anyone else, I was going to erect a tent in the parking lot. Beds were just that tight last night. On the hospital intranet page, there's an indicator of bed space status and I think last night (if memory serves) it actually said, "overflowing". President Bush: I've got your fucking health care cuts RIGHT HERE, ASSHOLE. I'll have more beds to play with once our new hospital opens...in a year from now. It certainly doesn't help when every other admission this time of year is for bronchiolitis.
However, I'm taking call with the World's Dumbest Intern. He's the heme-onc intern this month. It's well-known that he's the weakest intern link. The sickler went to his floor last night and he had two admissions other than that to do. By 12:30 AM, he still hadn't written any of his notes and when I was peeking in on him, he was staring at the computer screen, scrolling through the orders. ??? I flat out told him he's got to get faster, because on a day when his senior resident Caitlin is post-call, he's going to drown if he doesn't light a fire under his ass and get a move on. When we went to admit the sickle cell patient, I had him take the history. It was like being in a room with a third-year med student on their first rotation - it was very disjointed with no organization at all. He was asking all these questions about her pain - what does it feel like, how intense is it, how long ago did it start - and then moved on to medical history questions. He failed to ask WHERE THE HELL HER PAIN IS. He's four months away from becoming a second-year resident and he's just not ready. I would expect some disorganization and being flustered from an intern in the first month, not in the eighth month. All our other interns have figured it out by now and are great. He just doesn't have a fucking clue rattling around in his brain yet. This shall be the bane of my existence this month on my call nights.
Things I've taught my students so far:
-We treat patients. Not numbers, not x-rays or head scans. Patients. There is NO USE in getting a follow-up chest x-ray on a patient with pneumonia. Why? Because the x-ray lags behind clinical findings by at least two days. Treat the patient. If the patient, after 24 hours of IV antibiotics, is able to now walk down the hall without getting short of breath, does not have a supplemental oxygen requirement and generally feels better, then the patient's condition has improved. Chances are his or her x-ray will still look like shit.
-A corollary to this is that you only order a test if it is going to change your management. Going back to this patient with pneumonia: ordering a chest x-ray 24 hours after your first one and after starting IV antibiotics is NOT going to change the way you treat. You're still going to continue chest physiotherapy and IV antibiotics and IV hydration REGARDLESS of what that x-ray looks like.
I have a Scot on my team. I remember him from when I TA'd anatomy my last year of med school. He had the best. comeback. EVAR. yesterday when one of the unit secretaries told him she liked his accent. His reply?
"I like yours, too."
Scott, you rock.
I came home and slept for a shade over four hours. I got some sleep last night but it was definitely not restful, as I woke up every half-hour to check my watch. Today I've done nothing but bathe, wash dishes, and work on the NY Times Sunday crossword. Oh, and made nachos for lunch and roasted potatoes for dinner. It's like I'm in college or something.
My first day on 4A was a bit discombobulating but I managed. And I'm looking forward to what tomorrow brings.
Moment of Burrito: "The future will be better tomorrow." - Dan Quayle
I only had four admissions the whole day: pneumonia, broken arm, viral syndrome (a totally fucking soft call in my opinion), and a sickle cell crisis. Not bad. It could have been much worse. Had I needed to admit anyone else, I was going to erect a tent in the parking lot. Beds were just that tight last night. On the hospital intranet page, there's an indicator of bed space status and I think last night (if memory serves) it actually said, "overflowing". President Bush: I've got your fucking health care cuts RIGHT HERE, ASSHOLE. I'll have more beds to play with once our new hospital opens...in a year from now. It certainly doesn't help when every other admission this time of year is for bronchiolitis.
However, I'm taking call with the World's Dumbest Intern. He's the heme-onc intern this month. It's well-known that he's the weakest intern link. The sickler went to his floor last night and he had two admissions other than that to do. By 12:30 AM, he still hadn't written any of his notes and when I was peeking in on him, he was staring at the computer screen, scrolling through the orders. ??? I flat out told him he's got to get faster, because on a day when his senior resident Caitlin is post-call, he's going to drown if he doesn't light a fire under his ass and get a move on. When we went to admit the sickle cell patient, I had him take the history. It was like being in a room with a third-year med student on their first rotation - it was very disjointed with no organization at all. He was asking all these questions about her pain - what does it feel like, how intense is it, how long ago did it start - and then moved on to medical history questions. He failed to ask WHERE THE HELL HER PAIN IS. He's four months away from becoming a second-year resident and he's just not ready. I would expect some disorganization and being flustered from an intern in the first month, not in the eighth month. All our other interns have figured it out by now and are great. He just doesn't have a fucking clue rattling around in his brain yet. This shall be the bane of my existence this month on my call nights.
Things I've taught my students so far:
-We treat patients. Not numbers, not x-rays or head scans. Patients. There is NO USE in getting a follow-up chest x-ray on a patient with pneumonia. Why? Because the x-ray lags behind clinical findings by at least two days. Treat the patient. If the patient, after 24 hours of IV antibiotics, is able to now walk down the hall without getting short of breath, does not have a supplemental oxygen requirement and generally feels better, then the patient's condition has improved. Chances are his or her x-ray will still look like shit.
-A corollary to this is that you only order a test if it is going to change your management. Going back to this patient with pneumonia: ordering a chest x-ray 24 hours after your first one and after starting IV antibiotics is NOT going to change the way you treat. You're still going to continue chest physiotherapy and IV antibiotics and IV hydration REGARDLESS of what that x-ray looks like.
I have a Scot on my team. I remember him from when I TA'd anatomy my last year of med school. He had the best. comeback. EVAR. yesterday when one of the unit secretaries told him she liked his accent. His reply?
"I like yours, too."
Scott, you rock.
I came home and slept for a shade over four hours. I got some sleep last night but it was definitely not restful, as I woke up every half-hour to check my watch. Today I've done nothing but bathe, wash dishes, and work on the NY Times Sunday crossword. Oh, and made nachos for lunch and roasted potatoes for dinner. It's like I'm in college or something.
My first day on 4A was a bit discombobulating but I managed. And I'm looking forward to what tomorrow brings.
Moment of Burrito: "The future will be better tomorrow." - Dan Quayle