Post-call, take two.

Ahhhh, the weekend is finally over.

I got home today in a surprisingly really good mood for someone who'd been on call for 48 of the previous 80 hours. Last night wasn't awful. I saw four, sent two home, sent two to medicine, and accepted two direct admissions. Which I directed towards the second year resident. Because, ehhh, you know, she was sort of the direct opposite of June's extreme helpfulness the other night. And she was really passive-aggressive about trying to get me to not accept the the transfers which, we can't do that anymore without a legitimate reason (as opposed to our old reason, that we sort of like to keep the beds available for our own patients who come in, which apparently is not a legal practice. Somehow. Whatever).

I did have a rather unfortunate discourse with an ER doc at our affiliate hospital. Whose patient I accepted. But, so when I accepted the patient, the ER social worker said, "I don't know if this makes a difference to you, but he has no insurance". So I told her, of course not, we'll certainly accept him (let me repeat that - we WILL accept him), but you need to let the patient know that he is likely going to get a bill for his admission and he does have the option of going to the state hospital, where it will be substantially less. I told her it was approximately $1100/day here but we do have financial counselors who would be willing to work with the patient.

So there were a couple of little medical things I wanted cleaned up, and when I called her back to officially accept (ACCEPT) the patient, the ER doctor gets on the phone and is like, are you the one that told the social worker to tell the patient he'd be getting a bill? I said, yes. He says, wow. Well, you might want to watch that in the future, because that's a huge EMTALA violation. I said, no, it isn't actually, because we're certainly not going to refuse him because he has no insurance, but we tell our patients these things up front. And he says, all incredulous, but to give them a dollar amount? Don't you think that's some questionable ethics? I said, no, I think the patient has a right to know what he's getting into. And then the ER guy told me I had some "interesting" philosophies and refused to place the PPD I'd asked for.

Okay, first of all, it can't be an EMTALA violation because I took the patient (EMTALA, for those of you not in the know - and how lucky for you - is the anti-dumping law. What it really says is, you can't deny a patient emergency stabilization because they have no insurance. Somehow this has come to mean, at least in our fun and fabulous world of mental health, that you apparently can't reject a patient for any particular reason, either). Second of all, I think it's his ethics that are questionable. I guarantee you the reason this narcissist got mad at me was because State Hospital was on male delay and if the scary psych patient chose to go there, he'd stay in this guy's ED for another day or two. And beyond that, I'd want to know if I had that choice, wouldn't you? Say, a $5k-8k bill, vs almost no bill, in a facility that's not as nice and the patients are crazier but it's roughly the same doctors treating you (honestly? Having spent as much time as I have at both facilities, I'd take the bill. But at least it'd be my choice). It's part of empowering the patient in their own care, which I concede, is decidedly contrary to the old patriarchal model of medicine. The, I'm going to decide what's best for you (and for me) and you, patient, can just deal with that. Which is why it's old. And outmoded. And stupid.

I think he's stupid. Yelling at me at two o'clock in the morning over something about which he clearly knows nothing. And dude, I have degree in Humanities. Don't even start arguing philosophy or ethics with me unless you're prepared to bring your A game. I'm all about the Kantian bodyslam and the infamous Nietszche elbow to the ribs, baby.

Big stupid stupidhead.

Wow, maybe I've been hanging around with the kids too long.

But nonetheless. Because actually? Left in a really good mood, still in a pretty good mood. So here are five things, in no particular order, that contributed to my really good day.

1. The napping. Particularly the napping with my puppy. And then the lying in bed watching CSI and watching my puppy sleeping all hidden out underneath the chair in my bedroom, on which she used to sleep until I put something in the chair and made her sleep with me instead. (I might give her the chair back tonight. She clearly misses it). But seriously, there is no better feeling than the post-call nap.

2. Between leaving the hospital and my appointment with my shrink this morning, I went to the Borders to wander. And I found the best book ever. This book:

It's a parody of the Dangerous Book for Boys and the Daring Book for Girls, which are these cute and interesting compendia of random knowledge that everyone boy or girl should know (how to ride a skateboard...how to tie sailor's knots....how to properly set up a lemonade stand....etc). I actually looked at those on the way into the store today. They were clever. This one? So much better. Seriously, quite possibly the best book I own. Makes me giggle a really, really lot.

3. So one of the second years, we'll call her Maria, had a barbecue yesterday. Because, a, cookouts are what you do on holiday weekends, and b, in North Carolina we don't so much have "cookouts", we have barbecues. Which are different, because I tend to think of cookouts as general grilled meat, burgers, brats, whatever, whereas a barbecue involves pork and barbecue sauce around here (don't even get me started on the type of barbecue sauce, because that argument is apparently is a cause for justifiable homicide in NC). Anyway, Maria and husband had this barbecue yesterday, and I was very sad because I was not able to go. And then Mike randomly shows up with a plate of leftovers. He came in to the hospital to do some work while waiting to pick up another of our friends at the airport (I'm not entirely sure why, exactly, because Mike lives less than ten minutes from the hospital, and we can all access our charting system at home, and he was actually a lot closer to the airport at Maria's, but, nonetheless, who am I to question his motives when he's bringing us real food?), so he brought some leftovers in for the call team. Which was awesome. And then he hung around for a while and did some work and distracted me with silly YouTube videos of old 80s music. Which, how does Culture Club just not make your night better?

(Okay, no one tell Mike that I don't actually really eat barbecue. I'm working on it. It's the smoke flavor I can't quite deal with. And I have a thing about texture and lots of sauce and also pork. But I did have a little, last night, and it was quite good, as barbecue goes. Apparently Maria and her husband make their own sauce, and that's cool.)

4. I also picked up Jen's new book today. Haven't started it yet, because I got way too distracted, what with the dog book and the napping. But I'll let you know how it is. I expect great things, because Bright Lights, Big Ass was just so damn funny.

5. It was such an incredibly beautiful day here in NC. And I was finally out and awake enough for a while to enjoy it. It's been a remarkably beautiful weekend.

All in all, today, I'm really happy with my life.