Thursday, November 11, 2010

"I'm not gonna lie Doc."

Sometimes first impressions are....absurdly funny.

I walked in to a patients room this morning with this history: 50-something male who blacked out while driving Sunday, losing control of bodily functions, crashed his car into a pole, woke up and decided to drive himself home, then spent the next few days occasionally blacking out while continuing to drive himself around town. That is, until he decided to drive himself to the emergency room.

He had a history of cancer, drinking, and has enjoyed more drugs than there are ways to "just say no".

I'm real excited to meet this dude.

I head into the room, and he looks like he's been rode hard, dragged through some cacti, and put away wet. He has multiple scratches and thick blood-crusted scabs and bruises on him. His hair is thin all over. He is painfully thin. He looks a little wild-eyed. Then there's the trach that he cleans with his hand (imagine you could reach into the back of your throat and pull out all the snot and spit with a swipe of your hand, only to wipe it on the front of your gown before offering your hand to shake with the doctor).

"How are you doing today?" I lead with. Pretty benign, usually. He grunted something and grabbed his belly just around his stomach under his ribs--you can't talk and use both hands at one time with a trach, you need one to push your speaking button.

"Does your stomach hurt?" I asked next. He responded by clutching his stomach, holding up one finger in a "just one moment please ma'am" gesture, then, jeez this deserves a new paragraph:

He then took that one finger, pushed his trach button, and without a word, turned to his left, and projectile vomited coffee ground looking emesis, managing to arc it from his bed into a trash can.

This was not that man's first time around a vomit.

I am positive my head left a dent in the wall behind me because my first and only instinct was to back up so fast I flattened myself against the first surface I hit. Seriously, I moved so fast my arms flew up; it's probably more like a snow angel impressioned in the paint.

The guy had just had coffee, otherwise as you know if you're in the medical field seeing actual coffee colored emesis means the dude is BLEEDING in his throat or stomach, both of which could happen in a man with his history.

When he was done, he turned back to me, pushed the speak button in his trach and said, "SORRY. BEING AROUND PEOPLE MAKES ME NERVOUS."

"That's ok. I might throw up myself," I said.

Probably not the most doctorly thing to say, but come on, I'd just about given myself a concussion and two weeks ago I wouldn't have even been able to get words out before I yakked on his hospital bed. But it actually worked out; this guy started to laugh, and I could tell he was visibly more comfortable with me after.

The title of the blog comes from other events in this guy's day. A few conversations passed to me:

Neurology: "How much do you drink?"
Mr Bad Decisions: "I don't drink."
Nurse: "Your blood alcohol is still 0.05%"
MBD: "I only drink to take the pain away."

My attending: "So, you're having a hard time without alcohol? (the patient is in florid withdrawal by this point).
MBD: "Doc, I'm not gonna lie to you. I ran out of my Vicodin two days ago and I hit the vodka instead. It's the only thing that works for the pain. So I been drinking a lot."

Ladies and gentlemen, my favorite patient of the day.

Wednesday, November 10, 2010

I have work to do.

Right now. But I'm putting it off to dash off a blog.

I worked 91 hours last week. It is getting old. Some days I look at radiology attending positions just to remind myself that it won't be like this forever.

A patient I got really close to is probably going to die tonight. I've gotten in the habit of checking on her several times and day and again one more time before i go home. It's especially hard to leave oncology patients for some reason. I guess because most of them were going about their business when they got a crappy cancer diagnosis. It's a little different than the ones who seem to come in and out of the hospital playing the Poor Me card for painkillers or attention.

I think I actually like the Palliative Care patients the most right now. Since I'm not the final decision maker on treatment, something I can do really well is explain things to families and offer comfort.

Friday, November 5, 2010

Harassment

Sometimes nurses do not know when to leave me alone. I'm sure that today it was because a very angry patient would not leave them alone, but for craps sake when I'm taking care of 16 patients, sometimes I can't answer a page for five minutes!

Anyway, the point is, if you hear me use my slow, measured, somewhat quiet voice, you do not want me to have to come to the nurses station.

After being paged repeatedly and having my attending called despite asking for a few minutes to figure out what was going on with the patient, I stomped down the hall ready to rage to Death Star, a cute little nickname one particular unit in our hospital earned for having spazzy, constantly-paging nurses who somehow manage to miss things like, a blood pressure of 80/40. What do they page about? I spent two weeks and several nights on call and I still can't tell you.

"You paged me repeatedly on this issue. I have a patient with a systolic blood pressure >200, asked for five minutes to figure out what's going on, and every time you page me all patient care gets put off until I can answer the page."

I lead in with that for drama, then since I can never trust my hormones' next move, the urge to really mess with them came over me. "I have had use the bathroom for two hours but can't because I'm getting paged. I have to pee so bad my belly looks like THIS!" I then opened my white coat and gestured wildly at my newly bumped preggo belly. These nurses didn't know I'm pregnant, so the looks on their faces when they thought of how long I must have had to go before I looked like someone stretched a dress over a watermelon was PRICELESS.

"Oh my gosh I'm so sorry there's a bathroom right there I'll leave you alone!"

"Nah, I'm kidding. I'm pregnant. But seriously, I still have to go."

I am very concerned that unless I find ways to deal with the frustrations of intern life, I will have a rage baby who does nothing but cry until he learns how to yell obscenities. So I have to find ways to bring a little funny to the workday. I actually don't feel stressed the majority of the time despite working 70-80 hours a week. Of course, I say that this minute...