Wednesday, October 29, 2008

Last Call

We have a new attending this week, and I think it's fair to say that she doesn't like me very much. It probably didn't help that when she asked what specialty I want to go into, I was in a particularly foul mood and told her that I didn't want to do any of them. I'm so sick of internal medicine, and I'm REALLY sick of being asked what specialty I want to go into. My senior knew I was in the College program and helpfully piped up that I was going to be a researcher, not a clinician. That's not really true, but at least it ended the discussion.

At another point, the attending asked one of the other residents (not mine) why he had ordered a test that wasn't necessary to make the diagnosis. The resident said he had just wanted to see the results. I thought the attending would chew him out for ordering a purposeless test, but instead, she told him that if he had ordered it for educational purposes, that was fine with her. And people wonder why health care is so expensive! Our last attending had always emphasized how important it is to not order tests unless the results will change your management, and I agree with that philosophy.

Yesterday was my very last night of call. It wasn't a particularly good one. I guess all these long days and long nights were catching up with me, because last night I was really dragging. By 3 AM, I couldn't keep my eyes open any more and told my team I was going to bed for a few hours. I had just gotten all settled in the student call room when my pager went off. It was my senior wanting me to come down and see a patient in the ER. Swearing to myself, I got dressed again and went over there.

During the interim ten or fifteen minutes that it took me to do this, the patient was moved to one of the medicine floors in the H building. The senior told me to go to the H building and examine the patient. Now I was really pissed, because I had gone through the H building on my way to the ER from the call room. I went back to H, located the patient, woke her up again, examined her, and found nothing noteworthy. When I caught up with the senior, I told her that I wasn't sure what I was supposed to have found. She said she thought the patient might have had one eyelid drooping lower than the other, but it was very minor. I struggled to keep control of myself. Then she said with utter sincerity, "See, wasn't that worth getting up for? It's such an interesting case!" I contemplated strangling her to death with her own hair, but managed a weak smile. By that point, it was already 5:30, so I went to go preround on my patients.

Today was my last day on General Medicine, and I hope it wasn't too obvious when I dozed off during rounds this morning. We did have an interesting moment though when one of our patients wanted to check himself out AMA. It was freezing cold and snowing hard outside, so the attending asked the patient where he was going to go, how he would get home, and what would happen if he went outside with no coat on. The patient didn't have a good answer for any of those questions, and the attending decided he was delirious and wouldn't let him leave. We wound up pink slipping him. I got to go home at 1 PM since I was post call, and I have tomorrow off, ostensibly to study for the NBME on Friday. And that is the end of the General Medicine rotation.

No comments: