Avoidance

I haven't been doing much writing around here lately. Work in the PICU the past several weeks was somewhat monotonous. See the sick babies, write progress notes, round, check the babies labs, round again, blah, blah... in to work in the dark, home from work in the dark.

Sick babies depress me.

The unit was actually slow while I was there. Given the time of year, I had expected a lot of nasty respiratory illnesses, but most of our kids were post-op kids. Tiny runts on ventilators working with half a heart, or trying to breathe through little buds instead of lungs. Tubes in mouths, stomachs, chests, bladder catheters... little plastic octopi plugged into walls. And the beeping machines... yuck.

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On weekends I have been working at my other job. The extra money will be nice when it comes in, but it probably hasn't helped my attitude. Some days are good and I walk out of there confident and ready to start my upcoming new job, and some days are not so good. One of the other residents and I were on together the other day, and although I was in the room helping her for almost an entire hour, the patient ended up dying anyway. We have talked the case over and over since, and even though everyone has told us over and over that we did everything right, there's still that feeling of failure.

I don't know why I take it personally when patients die, but I do. If anything, we probably overworked the code-- shocking, giving every medication, and doing compressions so vigorously our joints hurt the next day. Obviously there will always be some that are too sick to save, but it just aggravates me when people die in front of me.

Up until that shift, I was thinking that I was ready to start doing single-coverage (working without another physician on in the department), but now I'm hesitant to do so. On the one hand, I think it will be a good while before I have a case that emotionally draining again. We were lucky in that both of us were able to devote our attention to the one patient, and because I was there, I was able to go back to seeing new patients and cleaning up the rest of the rooms while she spent the rest of the evening dealing with the family and other stuff. I can't imagine what the would have been like if I had been there by myself, especially as I soon got wrapped up in stabilizing a patient having a heart attack and getting him shipped out as quickly as possible. I haven't had the wonderful experience of having to run in between two or more unstable patients yet, and am not looking forward to it.

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Things are starting to normalize around here. I have umpteen projects to do before I put my house on the market in the next few months, and kept myself busy this past weekend taping and painting the hallway along the stairs.

AG is safe and doing well, although frustrated by his minimal trips "outside the wire".

I did my taxes already, now I'm just stalling on paying them until April.

I'm back in the department starting tonight, so at least I'll be around my people more the next few weeks.

Busted!

This year I have been moonlighting at one of the community ED's nearby. It's a different type of patient mix-- most of the patients are insured, and maybe it's all in my head, but they seem to be more polite, and actually follow-up with their private physicians. I typically work a shift or two a month for extra money. I don't want to miss any time that I could be spending with AG before he deploys, and to be honest, I really don't want to give up too many of my days off.

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Anyway, the other night, working at two different hospitals came in handy. I was working with my friend, M, and I grabbed the next chart and walked into the room. It was a young woman who was complaining of bilateral knee pain, and told the nurse that she hadn't been able to walk for the past 3 days. When I walked in, I was surprised to recognize the girlfriend of one of my patient's that I had seen the night before in my base hospital. I remembered her because he was there for a big, long rule-out appendicitis workup and she proceeded to hound the nursing staff constantly and paced back and forth across the department making phone calls (and demanding we feed said boyfriend immediately, despite his reported pain and vomiting, once it turned out that he didn't have appendicitis).

So, I called her on it, and she said she hid the difficulty walking the night before because she was concerned about her boyfriend. Fine. I asked her how she got to the hospital that night because when thinking about pain meds, you typically don't want to give a bunch of narcotics to someone who is about to drive home. That's when she said that she walked to the hospital. ???

Hmm, so I now I have someone who wants narcotics (allergic to ibuprofen, and acetaminophen "doesn't work") for an injury that doesn't make any sense. So, I gave her a shot of an anti-inflammatory that she'd never heard of, and sent her on her way. Reportedly, she'd had months of intermittent pains, no trauma/fall, and a normal physical exam, which to me means no need to waste any time with x-rays/imaging.

Just before she walked out to the waiting room, I ask her how the boyfriend's doing, and she says, "His belly doesn't hurt no more, now it's his teeth."

Hmm...

I sit down next to M, and see what he's up to. Wouldn't you know it, he's right in the middle of writing a prescription for narcotics for a young male with dental pain! I tell him the story, and mention how the guy just got discharged from our ED with narcotics the night before.

So, we both walk back to the guy's room, and I just stand there silently while M grills him for not telling him about the prescription he'd just gotten the night before. He doesn't deny anything, and just sheepishly says that he never filled the first one, but that he still has it at home. M tells him to go fill the first script because we're not giving him anything tonight, and out the door he slinks.

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I am sure that this happens all the time, but as I typically work just in one location, I don't see it that much. With electronic tracking, we now can easily look up just how many times someone's been in our department and what they've been given, so it's easy to tell if they have prematurely run out of their pain meds. However, there's no way to link between hospitals, so we can't really tell just how much someone's trying to abuse the system. This couple will probably still continue their quests for meds, but hopefully it will be to hospitals 3, 4, and 5 instead of the two I'm at.