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Text of the page (random words):
il she got there to take anything since one can t drive if taking narcotics she didn t have anyone with her because she didn t tell her son and daughter she was having the surgery until last night so that they wouldn t be able to miss work for her she takes care of her demented husband at home so had to be back quickly last night one of my post op patients rather than waiting 5 minutes for the nurse to page me for more pain medication called a rapid response from her room what she thought it would accomplish i don t know since it s composed of nurses who can t give narcotics without an order anyway then she called the operator and tried to bully her into calling my attending at home quite a contrast posted by chris emlyn at 5 48 pm 1 comments saturday february 07 2009 back this month i m again at one of the local community hospitals while in a lot of ways more relaxing than the academic hospital we only have two residents this month so we ve been pretty busy i started out on sunday thinking that i could round early take care of a couple minor issues then go to church for the first time in a month we take home call there so don t have to stay in the hospital if nothing s going on we just come back if there s a new patient or one of the current patients crashes that dream ended when i was paged at 5 30 am by the intern who had been on call saturday night to let me know that one of the patients had to be transferred to the icu overnight and was doing very poorly additionally a nurse just called him to let him know that one of the vascular surgery patients had a cold and pulseless foot which if true would be a surgical emergency so hopes of a quiet sunday crashing i went in to the hospital stopping at security to get my id badge and keys that should have been left there friday only none of the three security guards could find them i got them to give me a student id though so i had access everywhere i then proceeded to the icu first stopping to see the cold pulseless foot it was actually quite warm and i could palpate a posterior tibialis pulse though not a dorsalis pedis i looked through his chart and there was no mention of anyone ever being able to palpate a dorsalis pedis so i was not terribly worried i went to see the next patient and found that she had been made dnr dni no resuscitation or intubation if she crashed by her family she barely had a measurable blood pressure despite being on a high dose of vasopressors was completely unarousable and had dilated nonreactive pupils there wasn t really anything to do but i called my senior to let her know what was going on then i called the family and confirmed she was really dnr dni they eventually chose to pursue only comfort care so we stopped the vasopressors and she died within 20 minutes it was the first time that i had to pronounce someone dead and call the family fortunately they knew she was doing poorly so it wasn t a shock in between dealing with these issues i was also trying to round on all the floor patients whom i had never met before thankfully there weren t too many of them once that was done with we ended up having one or case that had been added on a pilonidal cyst excision i got to do the procedure which was nice by that time it was 3 00 and i went home nothing else happened so i slept most of the night i do have to give a little note about pager etiquette when you page someone you are essentially asking that person to stop whatever he or she is doing and call you back to be courteous you need to be at the telephone when that person does call back and you need to wait by the telephone for a minimum of 5 minutes in case they re doing something else and can t get to a phone after 5 minutes you can leave and let the clerk call you back when the person calls back it is completely unacceptable and actually very rude to page someone then leave the phone i mention this because there is one particular hospital we rotate through that every single nurse does this every time so that when i call back seconds after being paged i am then put on hold for five minutes waiting for her to finish whatever task she has left to go do and actually come back to the phone it is incredibly infuriating and essentially is telling whoever you paged that your time is worth more than theirs now i wait on hold for a maximum of one minute then call the secretary back and tell her to tell the nurse to re page me when she has time to talk it s gotten me a couple of apologies but they continue to page and leave the phone this doesn t happen at any other hospital i ve been to so it shouldn t be asking too much all right end of rant posted by chris emlyn at 10 32 am 0 comments saturday november 15 2008 kids i just finished a month of vascular surgery i saw and smelled more foot ulcers than i ever cared to see or smell and amputated more limbs than i cared to amputate people if you have diabetes please please take your medications and if you have neuropathies that have taken away the sensation in your feet you must check your feet every day if you smoke stop there are few sadder sights than a 50 year old man with both legs missing sitting in a wheelchair puffing away especially when you realize that he ll be dead from heart disease within five years i m on pediatric surgery this month it s been quite interesting though taking care of kids is not my cup of tea it s by far the busiest rotation at my program i m on in house call every second or third night it is a great rotation though with a lot of or time the attendings are great too they have two fellows and in order to give the senior fellow more operative time they only make him take in house call about twice a month to do this the attendings themselves actually take in house call in his place a couple times a month a bit intimidating for the junior resident if as happened to me he or she ends up on call with the chairman of the program instead of a senior resident but i think it says a lot about their dedication to the fellows education most of the cases i ve been in are pretty straightforward lots of abscesses appendicitis and pyloric stenosis but we also get all the rare cases as well biliary atresia gastroschisis etc the worst case i ve seen was a trauma that came in last week a one year old boy who came in without a pulse he had been beaten by his aunt that evening he didn t have any external marks but you could tell the second he rolled in the door he wasn t going to live we did the whole resuscitation anyway and got his pulse back for a while but when i shined a light in his eyes his pupils were completely blown and did not respond at all the ct scan showed what we all knew a huge hemorrhage in his brain he went to the icu and died a few hours later what makes it worse is that the police brought his two year old sister in a few hours later after taking the aunt into custody she had burn marks and sores all over her body including circumferential wounds around her ankles and wrists consistent with having been tied down for a long time and an old scar encircling her neck we did xrays of her entire body and found several fractures that had already started healing in malalignment she s doing well now but still starts uncontrollably shaking every once in a while her aunt was her foster parent since her biological mother is mentally incompetent even though she the aunt was a known child abuser yet the state still allowed her to keep the children and now one of them is dead the extended family has been in the little girl s room and acts very concerned and worried i ve been polite to them but not especially empathetic because frankly i don t think any of them should even be allowed to enter the hospital posted by chris emlyn at 11 10 am 0 comments wednesday october 15 2008 hmmm scene me sitting in front of patient s room in the icu vigorously writing admission orders and an h p middle aged nurse sitting a couple feet from me looking over a chart me to the nurse excuse me do we have a temperature on this guy nurse looking up at me with an irritated expression sarcastically no i haven t gotten one yet since i m kind of busy admitting the patient me a ight medical abbreviation of all right carry on nurse a minute later looking at the telemetry machine growling angrily he s having pvcs premature heart beats often caused by electrolyte imbalances i want labs who s going to get me labs nurse stands up and stomps furiously into room i follow me politely excuse me nurse angrily i need labs what labs me actually we already know that his potassium is low i just wrote an order for some potassium supplementation nurse angrily turns around looks at me opens her mouth with a snippy comment on the tip of her tongue suddenly she halts and her eyes grow big nurse pleasantly and apologetically oh i m so sorry i thought you were a medical student oh i feel so bad for talking to you like that let me start over i m laura extends her hand now doctor would you like me to give 20 or 40 milliequivalents of potassium oh i m so sorry for being so rude i didn t notice you were wearing a long white coat me it s all right no problem medical student standing behind me with mouth hanging open silence so apparently treating me like garbage would have been ok six months ago but is unacceptable now posted by chris emlyn at 7 27 pm 1 comments saturday august 16 2008 getting things done not always easy it s been an interesting couple of weeks although i m actually working the same number of hours this month as i did on trauma i feel much more relaxed we have been averaging 3 or 4 patients at any given time so i have just been rounding on 1 or 2 in the morning then going home around 3 or 4 unless i m on call so far nothing terrible has happened on call my attending for the first two weeks is very hyperactive and gets bored very easily he also has a very direct attitude i actually really like him he teaches and makes rounds incredibly entertaining the anesthesia residents used to lower key attendings didn t like him at first but are now coming around the nurses want to kill him which has made things somewhat awkward icu nurses at least the ones here are generally very good they only take care of one or two patients at a time so they know their patients well they are used to taking care of very sick patients so there isn t much that can phase them the problem is that their comfort levels are often so high that they think they know how to take care of the patient better than anyone else and they do all they can to get their way whenever one of us residents gives an order they disagree with we have to come by every twenty minutes to make sure that it actually gets done and that they don t forget or get too busy to do it there have been several times i ve asked them to do something one way and a couple hours later i ll come back to find that they ve done it the way they jolly well pleased this makes me very irritated i really respect icu nurses and they often know how things work in the icu better than i do if they suggest a plan different than mine more than likely i ll defer but doing the opposite of what i say without telling me is unacceptable and technically illegal there have been a couple occasions when they didn t like what one of the senior residents said so the paged the fellow over her head and lied about not having been able to get a hold of the resident they are usually better when attendings give orders the problem is as previously mentioned they hate my attending with a passion because he actually insists that things be done the way he orders so their solution is to call the surgeons with questions rather than the icu team this leads to the surgeons ordering things without our knowledge which leads to bad patient care from a too many cooks in the kitchen standpoint it has altogether been very frustrating and puts me far too often in the position of choosing between being undermined by someone who legally and ethically must follow my order or making an issue of it and becoming hated by the entire ward and subject to all their passive aggressive maneuvers so far i ve let things slide i m not sure how much longer i ll be able to take it many of the older nurses don t bother with the passive aggressive behavior they just flat out tell us they won t do something this is actually why they hate my attending they ve told him that a couple times and he s made them do it i m just getting so tired of the squinty eyed that s stupid i m not going to say anything but as soon as he leaves i m doing it my way facial expressions i think i find it particularly frustrating because i have always made such an effort to treat nurses like colleagues and despite how this post sounds i am actually on very good terms with the nurses in the icu which in some ways makes it harder posted by chris emlyn at 4 26 pm 1 comments sunday august 03 2008 icu i just finished trauma i am now beginning an icu month at the local va hospital i had my first call night on friday it wasn t nearly as bad as i was afraid it would be all our patients were stable and i was able to deal with all the issues that arose without having to page anyone higher up this month is particularly intimidating for me as 1 these patients are much sicker than any patients i have dealt with before and 2 when i am on call i am the only surgery resident in house as opposed to last month when i had a chief in the hospital with me whom i would run things by ever couple hours which means i have to page the fellow at home if i have a question about something on the positive side our patient census is very low i only had three patients to worry about another negative thing about this month is that it is at the va while i think the va here does provide good patient care it is to put it delicately a no frills kind of place for example my main hospital has a couple decent cafeterias one of which is open 24 hours a day when i don t get a chance to eat until 10pm i can still go down and get a hot meal the va has a cafeteria that is abysmal yet more expensive than my main hospital s and that closes around 4 30pm on surgery one doesn t eat dinner by 4 30pm there is nowhere else to get food you can see my dilemma fortunately on friday there was another resident who had to stay late so i was able to drive to mcdonalds and get dinner there this will not always be an option continuing on the no frills theme the whole hospital just has this atmosphere that is impossible to describe getting logistical things done takes 3 4 unneccessary steps it took me hours to get my computer access straightened out despite the fact that they gave me a login just over a month ago and getting meal tickets for call nights that i may theoretically be able to use some day was almost impossible all the employees from clerks to nurses have a this is the way we do things around here and nothing short of a presidential order no matter how logical or efficient 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