Tuesday, March 31, 2009

Sort of a Day Off

I had today off, but it wasn't very relaxing. My realtor met with me and did a walk-through of the house. I have a few more things to finish up and then a lot of de-cluttering to do. My plan is similar to what I do when my parents come to visit. I just throw a bunch of crap in boxes and shove it in the attic. I'll post some before/after pictures soon.

It snowed again today. Just a little bit of flurries, but it made me glad that the other day when we had "unusually warm weather" I slapped a fresh coat of paint on the deck outside to cover up all of the peeling spots. I would have liked my realtor to have been a little more optimistic today, but I guess I'll just have to see how it goes. I still think the house will show better in May when everything's green and blooming, but I would like to at least get people looking at it now.

Last night's shift was really busy. I typically average around two patients an hour, but I was at almost three per hour, and that was even with precepting an intern, which slows me up a little. I got so backlogged on dictations that I was there two hours past my shift discharging patients, slapping together splints, and stabbing at pockets of pus in the hallway and I still had to go in for an hour of catch-up work today.

The rest of the time was spent running errands... picking up empty boxes, grocery shopping, buying a shop vac to vacuum up all the cobwebs and spiders that have been breeding in the basement the past 3 years, etc.

Next week I head off on my "international medicine" rotation. Two weeks of sun, and working with limited resources. It sounds like fun... especially the nearby beach and hiking part. I can hardly wait. I'm really looking forward to lounging and reading a book in the sun.

Sunday, March 29, 2009

The Steamer

In my line of work, it is important to get along with one's coworkers. Doing shift-work means that we don't stay until the patient is dispositioned. Often a patient gets seen and examined, labs and imaging studies are ordered, and then their care is transferred over to the new doctor when it is time for the original provider to go home. In regards to patient care, this can be the most dangerous time for the patient as the incoming doc typically doesn't have time to fully re-evaluate the patient.

As you can imagine, everyone has their own level of comfort in decision making. After you get to know the other doctors in the group, you can typically figure out who is going to have more patients to sign-out because they tend to order more tests than everyone else, who is going to do very minimal work-ups, and who is going to intentionally order a CT scan fifteen minutes before the end of their shift so that they don't have to make the decision about what to do about the patient during their time in the department.

Like every other job, it's frustrating to get additional work handed over to you by people who seem to be determined to get by doing the bare minimum. It also stinks to come in to a full waiting room and patients who have been in rooms for hours, not seen by anyone, and the previous staff heads home seemingly carefree on-time.

At my place, we've come to refer to bad sign-outs as steamers, because the messes left behind are reminiscent of steaming piles of... well, you get it. Sometimes it's unintentional, but sometimes someone who's billed as "stable" suddenly deteriorates after shift change and it seems to be more a factor of a shoddy exam or workup because someone was in too much of a hurry. Extreme examples of this would be the patient signed out as "possible pneumonia" ending up needing a pelvic exam because their "rib pain" turns out to actually be belly pain, or in one really bad example, a "stable" patient coding in the CT scanner.

After being in a hospital for a while, you get to know how your night's going to start depending on who the previous shift was, and steamers definitely happen at both the attending and the resident level. I think that all of us ultimately want to do right by our patients and co-workers, but when there are so many interruptions in care throughout the shift, it becomes easily to get distracted, especially by the thought of it being past time to go home. It does get old after a while, and I can't imagine what it's like to be in the same place, taking bad sign-outs from the same co-workers over and over, year after year. While the names and faces will be changing out in a few months when I leave, I am sure the situation will be the same.

Wednesday, March 18, 2009

Eat Your Greens

I was talking with my mother the other day and she was telling me about some new sort of lettuce-type plant that she was growing in her garden. She couldn't remember the name of it, me- something or other. Jokingly, I asked her if it was mescaline, which she thought it might be, but clearly that is not it. Although that would make it more interesting when the javelina raided her garden.
As for working the overnight after St. Patrick's day, it wasn't too bad. I was expecting all sorts of drunks and injuries, but surprisingly, there wasn't a whole lot. We were busy all night long, and I had some very sick patients, and for some reason there were people who in the waiting room all night for little things like rashes and sore throats, but it wasn't the drunkfest I was expecting.

Monday, March 16, 2009


My attitude has been in the toilet lately. I'm not sure what did it: maybe working too much, maybe not taking the time to do anything fun/relaxing, or maybe I just need a change in pace. My vacation time is all used up, so that is not an option. Fortunately, I have an elective block coming up where I will be spending two weeks with some of my co-workers staffing a small emergency department in the Caribbean. Yes, there's work involved, but there's also a nearby beach, and plenty of sunshine.


I deal with violence on a daily basis at work: shootings, stabbings, and plain old assaults. To be able to handle it, you have to be able to separate yourself emotionally from your patient. Too much time spent imagining the pain of a steak knife entering your gut doesn't do anyone a whole lot of good; sympathy and empathy don't mix. Desensitization is a much-needed coping skill.

Recently, all of us were shocked by the death of a co-worker. She was shot by her ex-husband in front of their children. He later shot himself during a standoff with police. Both of them were brought in to the ED, and I was extremely thankful that I wasn't there when either one happened. She was someone that I knew, although not personally. I can't imagine the pain that those who worked side by side with her over the years are dealing with it, especially those that were involved in her care.

As expected, it is taking some time for people to go back to working the way they were before. It is somehow quieter, and more orders seem to be falling through the cracks, but people are piecing themselves back together, and reforming that protective shell that keeps them going.

Tuesday, March 03, 2009


Should I be creeped out that a teenage patient of mine called me "sweetheart" the other night? He's a manipulating emancipated teen that mainly comes in for med refills and to be fed a meal every now and then. I'm sure he has a lot of great relationships in his future.