Saturday, September 29, 2007
Friday, September 28, 2007
Wednesday, September 26, 2007
Monday, September 24, 2007
Thursday, September 20, 2007
The instructions were simple: Grab the rat by the tail with one hand and with the other hand, grab it just behind its front feet, high enough to cause the front paws to cross over each other. This helps to minimize struggling and at the same time, makes it relatively difficult for the little varmint to bite you.
Next week we go back to the lab to learn how to test for normal reflex and behavioral reactions. I knew that this study was going to require a lot of commitment, but I didn't know that golden showers were going to be one of the exposure risks!
Wednesday, September 19, 2007
To make things worse, I have been dealing with contractors lately... another particularly painful practice. My driveway is in horrible condition, and the "highly-recommended" person I called three weeks ago, finally bothered to show up the other day. Unfortunately, my driveway is too narrow for him to negotiate with his paving equipment. This has since sent me into a frenzy of phone calls, trying to get people to come out and give me an estimate because I would really like this taken care of before winter. So, to add to my already toasted Circadian rhythm, what sleep I do get during the day has been interrupted by random dudes calling me back or showing up at my door.
Having some experience in customer service in the past, I pride myself on being able to remain calm when dealing with your average jerk. The other night, this particularly difficult woman came in at 4 am, and I just wasn't going to deal with any nonsense. First off, she wouldn't narrow down her complaint. First it was nonspecific tremors, then the list expanded to include chest pain, left ring finger pain, and tongue pain. The "tremors" she was talking about involved her rhytmically flapping her hand on her chest. However, when she answered my questions, the flapping stopped, and only resumed when she remembered to start it back again.
Suddenly, she began demanding Valium. It turns out that someone has just been giving her this medication for over a year, without having diagnosed anything. Apparently she has now ran out. Oh, and prior to coming in by ambulance? She drank 2 inches of vodka.
I told her straight off that I couldn't see any reason to give her Valium, that I would like to workup her chest pain and other problems, but currently I had no reason to give her that medication. At this point, she refused any blood draws, stating that she was Jewish, and it was against her religion.
I went to enter her orders in the computer.
At that point, the nurse came in and told me that the patient was screaming and cursing. So, I went back to the room, where I was told that she was going to, "F***ing sue you so hard, you won't know what hit you." I again told her that I wouldn't be giving her any Valium, but that it was important that we make sure that her heart was ok.
At this point, the attending walks in, and the patient starts screaming at him that I am calling her a liar. I reiterate that I don't disbelieve that she had tremors, I just don't see any reason to give her that medication.
The attending and I talk privately, and he explains to her that the Jewish religion is opposed to autopsy (which sadly we will not be performing), but that blood draws are typically ok. So she agrees to the blood draw, and he compromises to 1 mg of Ativan, on the condition that she stays for evaluation.
Ten minutes later, she's screaming again at the staff, so I offer her another dose, and explain to her that she can just hit her call button rather than coming out and yelling obscenities.
Five minute later, she's demanding: a warm blanket, jello, and the "head doctor". The attending stalls on going back in there and thankfully she yanks out her IV and walks out. Everyone was silently rejoicing. I think she would have walked out much sooner if we hadn't caved to her demands in the first place. I just don't have any patience for people demanding medications without wanting to be evaluated. Even more annoying is that when people walk out, apparently social work has to contact them at home and ask them if they want to come back in. I'm pretty sure I know what her answer will be!
Saturday, September 15, 2007
Wednesday, September 12, 2007
Tuesday, September 11, 2007
"The other day" I walked into a room to find a 60's something female. She was brought in by ambulance, and the nurse was still finishing up reviewing her medications and getting her vital signs, so I walked into the room "cold". The only thing that I knew before walking in was that the word "Dizzy" was written on the whiteboard. Fine.
So, after walking into the room I begin interviewing the patient. I am a few questions in when a well-dressed woman in the room interrupts and asks me if the patient will be getting an EKG. I haven't decided this yet, but to get her off my back, I just say "Yes" because basically just about everyone over 40 gets an EKG... for just about anything.
So, I go back to the patient. The other woman then introduces herself as an internist and says that she works with my patient. She then proceeds to answer for my patient and gives me what details about the episode of dizzyness, only including what she thinks is important. She then adds that "I'm really anxious to see what my friend's 12-lead EKG looks like."
Finally, I get through my interview. As it turns out, the patient didn't just get light-headed, she has numbness and tingling in her left hand, foot, and although I don't observe any slurred speech, the patient is reporting that she just "isn't talking like her normal self."
So, I run through a quick physical exam, being sure to complete a full neuro exam. Now I'm thinking this isn't just a near-fainting dehydration/cardiac problem, it could be a stroke.
I duck out of the room. The attending is busy, so I quickly order an EKG and some meds to make the patient feel better. I give the attending a brief synopsis, and we decide to activate the stroke pager, which means that this patient basically gets pushed in front of everyone else in the hospital with respect to lab results, and imaging studies.
At this point, the internist grabs me in the hallway, and says, "Look, I don't mean to tell you how to do your job, but we still don't have an EKG." As she says this, the neuro resident is stepping into the room behind her back and the patient's nurse is putting her on a portable monitor to get her ready for the head CT.
I calmly tell the internist that the patient is not only getting an EKG, but she's getting evaluated for a possible stroke. Silly me, I had thought this would make her happy. She then asks me if I'm getting cardiac enzymes. I respond that they have already been ordered. At this point, I'm already daydreaming about punching this internist in the face.
I check up on one of my other patients, and see the internist pounce on my attending. By this point, the neuro resident is stepping out of the room, and she then proceeds to pounce on him, too. The patient is starting to improve, so it looks like more of a TIA or mini-stroke picture, rather than a full-blown stroke. Finally, to placade the internist, an EKG is done before the CT scan, and it is completely normal.
The CT scan doesn't show any hemorrhages and all of our labs come back normal. However, the neurology team is convinced enought that this is a neurological problem that they want to admit the patient and start her on a medication to help prevent any future events.
I walk into the room to make sure that the patient understands what is going on, and the internist is sitting there telling her who she'll need to see as an outpatient and blah, blah, blah. Finally, the internist leaves. At this point, the patient starts saying that she just wants to go home. Today, when I did my dictation I saw that she did actually get admitted.
I have several issues with the way this patient was taken care of. First off, if someone wants to accompany a patient, fine, but this woman was nothing but a hindrance from interfering with me speaking with the patient directly all the way through her workup. If she wanted to be in control of how this patient's workup went, she could have easily admitted the patient directly to the hospital herself.
There's nothing more annoying than patients that show up in our department with prescriptions for MRI's and other studies. I'm not running a lab. I'm there to actually evaluate patients and do some of my own independent thinking. If bloodwork or imaging needs to be done, then just send your patients to a place that does that crap and sends the results back to you without ever looking at it.
My other least favorite thing is when patient show up expecting their doctor (who usually is not even the one on-call for their group) to meet them at the door. When your doctor tells you to go to the ER, that means check in, get evaluated, and if the ER finds something we'll let him/her know. If they really want you admitted, then they do it directly, and you can just bypass our infernal lobby of misery.