Victory lap

Guess what, ladies and gents? Last night was my last night on call. Ever. Ever. Ever. So, exciting, right?! I'd been announcing to anyone who would listen, all day long, that they could never make me do this again. But things got busy, and I got distracted, and before you know it, we're capped with our tenth admission. I happened to be heading downstairs to the lab to look at a smear (blood, that is) when I realized my monumental accomplishment. I'd accepted my last patient. Whew. They can't hurt me anymore. Ever. Ever. Ever. So you know what I did?
I threw my hands over my head, and I ran down the stairs, yelling...
"GOOOOOOOOOOOOOOOOOOAAAAAAAAAALLLLLL!!!!!!!"
Now that's what I call going out in style.

Trash day

Way back when in my college days, I announced myself "head of the microbiology department" whenever it was time to clean out the fridge. Man, I found some gross stuff in there. I've relaxed a lot since then, but I resurrected my long-forgotten self-appointed title on call yesterday.
My current team room at the VA has the disadvantage of being the smallest room in the hospital. No joke - I've seen inside the janitor closets, and they are actually bigger. But that isn't the point. I'm trying to say how clutter and dirt is so much more oppressive in such a small space. And my interns are boys. And boys are dirty. (Everybody knows that.) So yesterday I tore through the cabinets and drawers, tossing supplies that were long-expired (guiac cards dated 5/07 - eww!). I even found (and tossed) a white coat with some serious ring around the collar. But my interns just didn't get the point. So I decided to ditch the subtleties.
I acquired a really, really big trash bag. (Thank you, friendly custodian man!)
I ceremoniously shook it open in the three feet of standing space in our tiny room.
I announced that whatever anyone wanted better be claimed by lunchtime. Or else.
And they ignored me. That is, until I actually started picking junk off their desk areas and threateningly gesturing to my giant trash bag. They finally realized I was real-deal no-joke serious about cleaning up.
And you know what? When we left today, only one pile of junk remained. Oh well, guess you can't win 'em all... at once. There's always tomorrow.

Be cool

Inexplicably, internal medicine has acquired a nerdy reputation compared to the tough guy surgeons. Oh wait, we earned it. It's not quite like the Scrubs "Sharks and Jets" bit, but close. In the scene below, my intern is assessing a patient, and the surgeon I've consulted enters the room. I follow shortly behind, just in time to hear this.

My intern: Oh! Hi! Uh, thanks for coming.
Surgeon: So, what's goin' on?*
My intern: Uh, yeah, uh, you know... we're just really worried about him. We, uh, yeah, we, uh think he has a really big bleed.
Surgeon: OK.
My intern: Don't those, uh, you know, need emergent surgery? I mean, it's giant!!
Surgeon: Sometimes. But he looks fine. What's his pressure?
My intern: (fumble with giant stack of papers) Oh, it's, um 123/74. Heart rate, mmm, 68.
Me: (in my head) Dude, calm down! Deep breath, play it cool. He's not gonna take you seriously!
Surgeon: Those vitals sound stable. Let's just get a CTA, take a look at that aneurysm.
Me: Yes, good idea. I was just concerned since he's actually had a ruptured aneurysm before, and this one is over 7cm now, with recent abdominal pain. Thought it would be better to call you now, before it gets too late and you know... ruptures.
My intern: Oh, uh, hey! I was just telling [Surgeon] here about our guy. I'm, like, um, really worried about him.
Surgeon: Yeah, I gotta check on somebody bleeding out in the SICU. Call me after the scan's back.

As he exits, you can almost hear the ice water coursing through his veins.

And there was no exaggeration in that. None whatsoever.

*Imagine John Wayne's nerves of steel in Patton. You could even add a "little lady" to the end of that statement. Never mind that said intern is male.

When reputation precedes you

The time is 5:57pm, the scene the CVICU on cardiology consult rounds. My stomach grumbles so only I can hear. The characters are myself and my two med students - a fourth year at Vandy and a foreign med student doing a month-long rotation here in Nashville.

Me: Sigh. I'm so hungry. I could really go for a great big steak right about now.
Foreign student: Yeah, me, too.
Vandy student: Yeah... Wait, what? You want a steak? You look like such a vegetarian. I dunno, you just don't look like you eat steak.
Foreign student: She's from Texas. Of course she eats steak.

Survey says... he's ready for America, or at least for the South.

Miss Manners

As recently mentioned, I'm on the cardiology consult service right now. This means I don't admit any patients of my own; rather, primary (admitting) teams call me for help. And if we're being honest, we'll also mention that they really want my attending's opinion, not mine. But the idea is that you, as a consultant, opine on a specific issue. It is good consult etiquette to ask a "clinical question" and not just generically request that the consultant "come look at" or "get on board" with a patient.
Some people have trouble with questions. Like kindergarteners. You know Jen, right? My BFF who teaches the wee little ones? Well, I've heard her ask them if they have questions after giving instructions. A tiny voice will pipe up with, "Last night, when I was getting in bed, my dog ran in the room and jumped in bed, too." And she will respond with, "No, no. That's not a question. That's a story. Questions ask who, what, when, where, how or why. Can you ask that as a question?"
Consult-requesters frequently have the same problem. In the "reason for consultation" box the resident will put something like "79y/o man h/o HTN, CAD, ESRD on HD p/w SOB."* I seriously fight the urge to call back and say, "No, no. That's not a question. That's a story. Questions ask who, what, when, where, how or why. Can you ask that as a question?" But instead I'm diplomatic as can be and politely call the person back and inquire as to what specifically they want me to accomplish with the next hour of my life that will be spent digging through years of data on the guy.
And I invariably hear on the other end of the phone, "(pause) Well, you're cards. He has heart disease. We just want to get you on board early." But the best of the worst I've ever gotten is (I kid thee not), "We just don't really know what's going on. Can you come see her?"
At least they phrased it as a question.



*79 year-old man history of hypertension, coronary artery disease, end stage renal disease on dialysis presents with shortness of breath.

A regular comedian

While typing out my cardiology consult notes this morning, I found myself sitting next to the resident who took over the heart failure service from me.

Me: How's Team Failure?
Other resident: Gross. I can't believe you're still doing cards. Don't you just hate it by now?
Me: Um, yes. It really makes me wanna pull all my hair out.
Other resident: Yeah, I hear ya.
Me: But then, I'd be ugly and still on cards consults.
Other resident: Yeah, that would be a real lose-lose situation.

Let the riotous laughter ensue.

Breakfast of champions

I Scovilled last night. (That means moonlighting.) Twas a crazy night, and I didn't sleep much. And by that I mean at all.
And yes, as a matter of fact, I did eat my cereal from an emesis basin in my call room this morning. No better way to start your day, I say.