My life is weird.
So, today, I walked onto the unit and was immediately like...ohhhh....
Which, it turns out, was warranted. Five out of my nine patients were new. Two of them didn't speak any English (fortunately one of my rockstar medical students is reasonably fluent. And now I know how to write prescription directions in Spanish. Una pastilla antes de dormir...). So we rounded, and I started out with no discharges. And then as the day progressed, two of my patients' families convinced me to send them home. And one of them begged me not to discharge her tomorrow, as planned, because...well, honestly, because they really would prefer she were in the hospital forever. This happens a lot, actually, the, "Can't you just keep them until they're, you know, fixed? And thus no longer a bother/source of stress/imposition to me?" Sorry, no. But I feel your angst. Well, except for that "imposition" part.
You know how sometimes, you're reasonably sure you're doing the right thing, but there's that tiny little sliver of doubt that nags at you? It's always hard to know when people are really ready to leave the hospital. They tell you they're ready when they aren't, they swear that they aren't ready when they really are, and so often all you really have to go on is your clinical judgment. So, basically, your gut with a little more education. Sometimes you throw them out of the nest and they soar; but sometimes, you make a safety plan, you have a foolproof aftercare plan in place, you let them teeter on the edge of the nest for a moment and survey the land before you tap them gently...and they plummet to the ground and flop around for a while. If you're lucky, you, or some surrogate agent of you, are still there to shake your head and scoop them up and mumble things about bumblebees. If you're not...well...that's what keeps us all up at night.
I had a discharge like that today. I think she's okay. I think her family will take good care of her, and they really, really want to. She's not as stable as I would've liked, but I think that she'll fly better with her family around her instead of a bunch of crazy people who don't speak her language (not to mention the patients). Still...I worry. I had another discharge like that on Friday...called her today to check up and tell her that her labs were okay, and of course, she's doing great, and the weekend at home was just what she needed.
I mean, obviously, the attending backs us up, and it's ultimately his decision, but he more or less places his trust in my judgment. And some day, he's not going to be there, and it's going to be all me. It's a lot of responsibility. Particularly when you work with a population who, can say all the right things, tell you what you need them to say, convince you they're okay and look genuinely better....and then go out and kill themselves the next day. It happens. It happened to us last month. So you either become an administrator, or, you worry.
And sometimes, you just shake your head.
One of our patients, whom we discharged on Friday, came in Thursday night high as a damn kite and swearing he was going to kill himself, or maybe someone else, I don't really remember (he wasn't one I was responsible for). And we interview this guy in the morning, and he says, all fabulous, "No way would I kill myself. I'm too cute to kill myself. I mean, I know that sounds conceited or whatever, but, look at me."
Can't argue with that logic. Even from a scrawny little white-bread queen.
Then there's this other guy, shows up on our unit today (not sure who he was, could've been a visitor), with "PUMPKIN" tattooed on one forearm, and "NOODLEZ" on the other, such that when he puts his fists together, it reads, "PUMPKIN NOODLEZ". We spent a lot of time today speculating on that one. Kevin, my co-resident with the same last name as me (just to confuse all the staff), says, "Is that a gang tattoo, maybe? Like, 'Beware the harvest season!'?" I literally almost fell off my chair in the middle of treatment team. This came up again later, of course, with the girls in Admissions and my friend John, who says, totally deadpan, "I bet they gave it to him in prison. He was somebody's bitch, and they named him Pumpkin." And then he adds, all coy, "Come heeeeere, Pun-kinnnn". I, of course, had been busy noticing the detail work on it earlier, and was like (totally serious), "No...it didn't look like a prison tat..." He smirks and counters about how they have some seriously good artists in the joint these days. I, by then, had figured out he was kidding, and pointed out the lack of fine-tipped vibrating needles. And then ignored him when he asked me why I knew so much about tattoos...
The party, last night, by the way, was faboo. Doc G lives out in the woods, in this place that reminds me a whole lot of the area in which all my classmates lived in New Hampshire, except without the skiing. We had a hell of a good time. The food was awesome (catered from this Mediterranean place in town), the beer was cold, the company was excellent. Doc G is a funny, funny guy, and only slightly funnier than his wife, Doc D, who is a trauma surgeon. They have this massive house with two decks, two balconies, and floor to ceiling windows everywhere...and a can of Spam on their mantle. Outside, there's a koi pond, a hibiscus with flowers the size of hubcaps (so not kidding), and a six foot tin chicken. No, I don't know. Oh, and there's also...a Howitzer. I don't know why.
That's their cat. With the Howitzer. Click on it, you have got to see the expression on the cat's face. I don't remember the cat's name. But holy cow, it was a nice evening.
We spent some time talking about my patient I'd had who I spent an entire week fighting with Medicine to take her on their service because, let's face it, we're not equipped to provide that level of medical care, as sick as she was, on our unit. She was originally Doc D's patient when she came in (on account of her self inflicted stab wounds), and then she was Sparrow's, who handed her off to me when I came on service, and then she became Doc G's, when medicine finally took her (he was the consulting attending).
I got to work today and discovered she'd died this weekend.
You know, the last day she was on our service, when I finally just called them out on their bullshit, and she was full of crackles and her fingers were turning blue (ominous sign, ps) and she could barely get out the sentence, "I still want to die"...I said this to the medicine residents. I had said it outright to the ones with whom I'd been arguing all week, "You know, I know she wants to die, but I don't really want to help her, here." They made fun of me. That last day, I was like, "I'm not kidding. I'm not going to facilitate her exit." And then something along the lines of, come fucking do your job or I'm going to find out a way to do it for you. Which, it's not like I have ICU admitting privileges, which is where she needed to be, so that was an empty threat. But I told them. And now she's dead. And that just sucks.
I'd better go to bed. I can only guess at what's in store for me tomorrow...