Throwback

So I'm postcall.

I know, I know, I said I was never going to have to take call again, there may have been a happy dance involved, etc. But, to clarify, I believe what I actually said was more that after that, any time I was doing "call" it was going to be voluntary and heavily compensated. And this was.

I think we killed Veronica on Friday. She and I left Friday night about the same time, she'd had one beer, she was looking a little peaked, but well, she's an intern, they always look a little peaked. We left because she was on call yesterday and I was just freakin' tired and had shit to do over the weekend. So I came home, blogged, stretched out, fell asleep a little after 1. Woke up at 7:15, of course (after waking up at 5), and was sort of dozing, mostly refusing to get out of bed, and my phone rings. And it's one of our chiefs, and she's like, "The intern is sick and can't take call. I'll give you three comp days if you do it."

Once I actually woke up, I was like, hell yeah. I'm all over it.

So I made a mad dash for the shower, found my scrubs, ran out the door, and despite my commute and the proximity of her calling me to the start of the shift, I made it by the end of checkout rounds. I was on with Scott, and we had a rockstar medical student (also named Kate). And two new ED evals waiting for us by the time I got there. So Scott went off to Second Year Consult Land, and the Kates headed down to the ER. Go team. Break!

It was a constant stream. We were essentially bedless, so there was a lot of referral action going on. It was a crazy shift. I didn't see my office after I dropped my stuff off in the morning, much less my bed. And for that level of chaos with two upper levels on, I can't even imagine how awful it would've been for a sick Veronica.

Crazy.

But interesting, and amusing in a lot of ways. We had some really good cases. Scott and I work well together, and Kate did a great job. We functioned as a remarkably good team, actually. And we had a couple of short lulls. One was like early evening, when Kate was still there, and we had a very good discussion of object relations and projective identification and a whole bunch of related nonsense that Scott and I are both pretty into, and she seemed to really enjoy. The second was sometime after midnight, when Scott and I finally got around to ordering dinner (one thing I did not manage to do during my AM Tasmanian devil impersonation was grab any sort of provisions for the day, because, well, yesterday was my day to go grocery shopping...). Of course, we hadn't had lunch until 3:30pm, so, midnight seemed pretty reasonable to us. Tarheel Takeout had already stopped delivering by the time things quieted down enough for us to think about food again, but we discovered this pita place nearby that delivered, and was pretty tasty. Good falafel. He and I also had a chance to decompress a little about some issues in the residency that we generally agree on, but on which we often have different outlooks.

One thing I found especially amusing yesterday was how shocked the medical student was that we all talked so openly about being in therapy. We both kind of shrugged and were like, well, how are you supposed to see things in other people's patterns if you don't know anything about yourself? I gave her my standard line of, I really think the key to being a good therapist is having a good therapist.

It also was remarkably helpful that I was on last night in that one of my patients had to come back in to the hospital, and I think it made it a lot safer and easier for her that I was there. She and I have a good therapeutic alliance, and wow, she really looked like hell when she came back in. We talked for a bit, she cried a lot, and by the time I'd gone back in to have her sign the paperwork, some outside influences had made things even worse. I hugged her before I left. We try to use physical contact very sparingly and with intention in this business, but sometimes, a simple pat on the shoulder or a careful and genuine hug can be the single most therapeutic intervention.

But while it was really good for her that I was there, it was really pretty upsetting to me that she came back, for reasons of my own neurosis. I, obviously, was so glad she was able to come back and to be safe and ask for help, but the transference in our interaction being what it is, and my own internal critic being as it is, and the fact that I was sleep deprived going in to the shift and had now been awake for like 21 hours made it really hard for me to see her looking as dysphoric as she was so soon after I'd last seen her. People who aren't in our profession really don't understand the depth of the internal tumult that goes on when you're surrounded by the sort of external chaos that we are.

The end result of that last night, unfortunately, was me yelling at a Neurology consultant who was trying to dump work on me in a pretty condescending manner. I actually hung up on him. Scott's commentary on that was somewhat pointed (see above re:sleep deprivation). He was like, "He's a good guy. I'm not saying he wasn't an ass to you right now." I ranted for a moment and then turned to him and said, "You can tell me if I'm being unreasonable." He thinks about this for a second and says, "Emotional, maybe. Logically, that was a reasonable request, but the emotions are out of proportion." I couldn't argue with that. Later, after the neurologist had actually done what I'd asked him, and I'd done what he'd wanted me to do, and I finally did agree with him that the neuro exam was pretty unrevealing in that patient, I paged him and apologized.

Interestingly, the apology was what Scott got kind of snarky about. I was driving home today and thinking that whole story arc of last night was a whole kitchen full of pots and kettles....

On the plus side, I did get a couple hours' worth of postcall nap in this afternoon. Oh, there is no greater bliss than a good postcall nap...

So now I'm actually going to go to bed, because I do have a 7am therapy patient tomorrow, and it's been a long damn weekend. But, really? I love my job.

Coverage

Every now and then every girl needs...

Which is a reference to this song:



(I really like Leann Rimes. Like, as an entity. She's grown up quite gracefully.)

Today did not go especially well.

Call was fine. I was on with Scott and then Fang. Scott, who was on for the third time in five days and was supposed to leave by 10pm, left at 2am. Which was partially my (and Fang's) fault - we kept talking to him. If we'd just ignored him and made him write his notes, maybe he would've gotten out of there before I went to bed. But on the whole, the evening did not suck.

Strangely, I'm not as excited about this "end of call" thing as I want to be. I'm a little freaked out by it, frankly. Like, it definitely marks the end of something, a change, an evolution of my professional life. For the past seven years it's been part of my identity. Even when I was "on sabbatical" and not actively taking call, it was something I did, planned to do again, a fact of my life. It's something that is very different from normal people's jobs.

I don't think I'm trying to say I'm afraid to be normal. I just think, it's a shift. A harbinger of change.

I spent a good deal of time today contemplating the difference between novelty and change. I like novelty. Change makes me anxious. But I'm not entirely certain how they're different.

Gomer sent me a weirdly cryptic text yesterday afternoon, saying "be sure to watch the news tonight for important gym information." I was like, what?? I finally pestered him again around 11, because there was no "watching the news" in my evening, and he confirmed what I've been saying for over a month - our gym is closing. June 30th. Frack. So we talked about it a bit and came up with a plan because they were going to relocate him to the location Ruthie goes to. It's a meat market, and everyone from work goes there, but I like my trainer and so, fine, for him I'd go to Ruthie's club. Except then, this morning, there was this article in the local paper saying that the chain is closing all of the Triangle locations within three months.

I'm so not pleased. I like my gym. I like the people at my gym. My gym is comfortable and generally emotionally safe. I have gym friends. Where are we all going to go?

Allegedly, the gym that's next door to my apartment bought out all of my gym's current contracts. Which, I guess that's handy. I don't know what that means for me and Gomer. I like Gomer. Gomer and I work well together. He's pretty. He's also comfortable and generally emotionally safe.

Do they not understand how hard it is for me to go to the gym in the first place? Some day I'll post about just how unbelievably charged this whole thing actually is for me...

I also got my TSH drawn today. My doc and I have been steadily increasing my dose of thyroid hormone for several months now. At the last draw, it was down to high-normal, which meant it was responding to a reasonable dose of the meds. That was three months ago. Today? The highest it's ever been. What the fuck, people? That makes no sense.

I also got called into the principle's office today. Okay, because of a problem I went to her with, but I have to go meet with my program director tomorrow. I feel like I'm so very in trouble, primarily because of the way she worded her email, which was not actually indicative of me being so very in trouble, but rather of her paying attention to what I was saying. However, she happened to use the exact same phrase that my program director at the Emerald Palace used to basically tell me they wanted to put me on probation ("We should talk about this." Not exactly an uncommon bit of verbiage). That's definitely not what's happening here. But logically knowing that doesn't make me any less anxious about it.

A couple of other things happened. All in all, it was not a good day.

But then, I got a little nap, got a little shower (since I finally went to the gym today, and of course, now there's NO air conditioning at all), and went and picked Maggie up from the daycare. And then I went and got a cheap manicure at this place I went to a couple of times when I lived here first year. They're extremely reasonable and they do pretty good work. And then I went and had dinner with Sparrow and Rene at this local Mexican place I've been wanting to try (Ruthie got lost and Peng was on call, but I like to think they were there in spirit). And by the end of that, I felt so. much. better.

LeAnn knows what she's talking about.

Thanks, ladies.

You don't have to go home, but you can't stay here.

(which is a reference to this song. In case you missed it)

It's Last Call, people.

Barring extenuating circumstances, tonight is my very last overnight in-house call EVER IN MY WHOLE LIFE. This boggles my mind, because as an OB, I could've still been taking call the day I retired. Psych? Notsomuch.

This is beautiful.

It's also really, really weird.

And it's also 2am. So, I'm going to stretch out on our little pink chair for the last time and get some zzzs in while I can...

Answers

Oh. And in answer to some recent queries...

1. Carol - I bought yarn at the yarn store. Ha! No, seriously, I bought two colors of this merino/silk blend and a ball of Kidsilk Haze for projects which I will detail later. Maybe this weekend, maybe after Peng's wedding, but probably this weekend because they're not exactly secret, and only one is for her. I just need time to sit and write about it.

2. Maggie only gets to go to daycare when I'm on call, which means, sadly, that she only has one more little visit to daycare left (that's sad for her, not me). I mean, she'll stay there when I go home in July and December and when I go to Hawaii in October and any other times I might choose to leave town without her, but for the day to day, next Monday is it. However, we have a very nice dog walker who comes every day. He's an older, retired military guy and she adores him. He's really very fond of her, too. I like having him come, but I wish I had the funds to maybe put her in daycare one day a week, because I KNOW she loves hanging out with the other dogs. When I'm not post-call, though, I rarely make it home before 6pm when their pickup hours end (which is why the dog walker comes this year, because my days are looong). So maybe when I'm a Child Fellow, on the day I'm at State Hospital all day. We'll see.

3. I have not, I promise, forgotten about the prizes from the lyrics contest. I've just been working too much and moving (Julie moved, too) and now I can't remember where the post office is. Plus, Jenn, I have some finishing touches to put on something that's going in your box. But I need to send that stuff out, soon, because I'm thinking of doing the lyrics contest again. That was fun. But...patience. I promise it'll be worth the wait, and I'll be more expedient next time (that's a lie. I just moved the box of Barb's stuff I was going to mail to her for Christmas. Which is lucky, because we had to add something for the puppy). Hopefully within the next couple of weeks. (Julie, you need to Facebook me your new mailing address!)

4. I had a really, really long day. So long, in fact, that I just typed "That was fun. But...patients." And then looked at it for a good twenty seconds thinking, no...that looks wrong... So I'm going to bed. Oh, but not before I add...

5. Anonymous - NO PANTS!!

Worst. Consult. Ever.

So I get this page...

Me: Hi, this is Dr. Kate, I'm returning a page?
Her: Yeah, hi, this is so-and-so med student, I was hoping you'd do a consult on my patient.
Me: What's her story?
Her: Well, she has a history of Crohn's disease, and is on prednisone, and four years ago when she was on prednisone, she became psychotic.
Me: Okay.
Her: So will you see her?
Me: Is she psychotic now?
Her: No.
Me: ...um...then there's not really anything for us to do.
Her: Well, also, four years ago she was discharged on Abilify, which she hasn't taken in about three and a half years. Should we restart her on this?
Me: Is she psychotic?
Her: No.
Me: Well, then let's hold off on the anti-psychotics.
Her: So my attending would like you to see her because he's worried about keeping her on the prednisone.
Me: Well, she's tolerating it. And not psychotic. So I'd say, if she needs it, keep doing what you're doing and call us back if she gets psychotic.
Her: Yeah. Okay. Thanks.
Me: Anytime.

Apparently, this whole exchange actually started with her paging Scott, my intern. Who told her she was paging the wrong person. And then added, "So, I'd start out by telling her you're a medical student. Because, otherwise? I don't see this going well..."

Nosh safely

There's a patient in the ER with a chief complaint listed as "snack bite."

Looking at the actual note, it's possible this could be a typo, as the story involves a snake, not a hamster covered in steak sauce or perhaps a rogue potato chip.

Still. Be careful out there tonight, people.

I'm hoping to get Doritos to sponsor the blog...

No, not really.

But I was wasting some time this morning (I'm on call. And pleased to have a little time to waste. Did I mention that today is my LAST SATURDAY CALL EVER? 'Cause it is. That makes me happy) and came across this, which made me a little nostalgic. I remember watching Wayne's World in junior high, while I was babysitting for the little girl across the street. I made microwave popcorn and tried to make hot cocoa on the stove. It was terrible. We drank it anyway.



Ahhh, Wayne and Garth. Still think the skits were generally better than the movie, but it was iconic. Even if the Cars on a Memo Spike thing was in North Riverside, not Aurora.

Party on.

Best call ever

Today did not start well. I slept fitfully last night...had trouble getting up this morning, even though I got to sleep in. I'd planned on going in to work late, I ended up going in early. I was cranky. I was sore (I think muscles hurt today that I'd completely forgotten about. Seriously. I'm pretty sure my sartorius muscle hurts. That's kind of a rough one to make sore, frankly. I think it was the whole "bob and weave" thing yesterday). We had a meeting, and then lots of lecture, and then I was on call. I washed my scrub pants this morning so I could wear them for call tonight, but didn't actually remember to dry them before I had to leave. So I left them on my chair in my office to air dry. And then, of course, there was the actual being on call.

But then guess what happened.

My puppy came to work!!

(Okay, that's an old picture, from when she used to go to work with me at the yarn shop.)

Don't worry, Peng, we didn't let her in the office. Sparrow decided it was a nice night for a walk, and brought her up to the hospital. We were all hanging out writing notes when Sparrow called the workroom and was like, "Hey, I need a STAT psych consult on a nine year old female out here on the loading dock" (Maggie's only 7, but she didn't seem to mind). I hung up and said, "My dog's here, folks, I have to go." So my intern Julius was like "...can we come? I could use a little pet therapy." And so Tyler, Julius, the med student and I all went down and stood outside in the lovely evening for as long as we could manage without getting paged, which was actually a decent amount of time. Maggie was thrilled, and beyond wiggly. She dragged poor Sparrow clear across the parking lot when she saw me. It was the sweetest thing ever. Certainly made my whole night. Might have made my whole week.

Gosh, I love that dog.

(We're both pretty fond of Sparrow and Maxine, too.)

Still what I think

First and foremost, a happy Mothers' Day to all of you who are moms, will be moms, or have a mom (so, if you were born, I'm probably talking to you). But, most importantly, to my mom. Hi, Mom!

Go read this. It's Bob Greene's column on this Mothers' Day. It's lovely.

I had this whole blog post written, ranting about silly things like transcription software and being on call (which I am), but then I decided I was done being grumpy.

I probably should go see if my intern wants me to see anyone in the ER...there's a couple of people down there for us, but he has a solid medical student, and I don't know who we have and haven't been called on, yet. So I'm waiting for him to call me.

I saw the consult list this morning, passed the buck on a couple of them, nodded at a couple others ("You still okay? Okay."), wrote some notes. I got caught up on my dictations, read CNN.com, called my mom and dad (Hi, Mom and Dad!). There's people everywhere outside, because it's graduation day at Baby Blue. I'd complain about how they took away my close parking (that's the only redeeming thing about weekend call!), but, I said I was done being grumpy. And, on the whole, I can't complain too much about today.

I could wax philosophic, I suppose, on mom-ness, but, I did that at length last year. I still think parenting is the most important job, ever. In all the ways it can be done.

It's been brought to my attention this year that one of the benefits of having child therapy patients is, to quote one of my mentors, "you have a real opportunity to be, yourself, a developmental object for them." I think about that a lot, with my two adolescent therapy cases. It's interesting to me, actually - I feel like I'm way more invested, far more present in the room and "settled" (ahem) in those cases than I am with my adults. I wonder what that's about. I suspect it says something both about how I respond to them and how they respond to me. Gosh, I do enjoy those two kids, though. They really are just amazing, amazing women-in-training.

I will say, though, I'm glad they're still attaching to me and I'm not the object of their separation-individuation efforts, yet. Wow, Moms of teenagers, that's rough for everyone involved.

It's so funny, really, to me, to think about where I was 53 weeks ago (completely terrified of the Child and Adolescent rotation) compared to where I was one week ago (freaked out about potentially not getting a Child and Adolescent fellowship). The beginning of my personal statement was this story from med school:

In medical school (back when I thought I was going to be a high-risk obstetrician), I remember having a conversation with a friend of mine who was going to become a pediatrician. He was discussing how he was thinking of doing a fellowship in Adolescent Medicine, and I shuddered a little. “Adolescents are mean,” I told him, “even meaner than kids.” He laughed and said he knew me better than to believe that I meant that, and added something contrived about how one day I would change my mind. “Nuh-uh,” I declared, and in my best childish form, stuck my tongue out at him.

Five years later, he has a general pediatrics practice, and I find myself yet again humbled by my life’s irony.

(Have I mentioned how excited I am that I get to be a fellow? That's just so weird...)

Oh, and in totally unrelated news, did I mention that, when I leave in the morning, I'll be on vacation for a week? I'm not actually going anywhere...I'm going to try to find a new apartment and figure out when I can move and pack up as much shit as possible. And sleep in, and eat things that don't come from a freezer, a drive-through, or a hospital cafeteria, and hang out with my dog, and watch the TV shows I follow, when they're actually on, even if they're reruns, just because I can. And not see patients, and leave my voicemail to the very competent Peng, and maybe read a book that has nothing to do with psychiatry. And pay my bills, and go to the gym, and see my shrink (who's been on her own vacation for three weeks).

I might need two weeks...

Oh, but when I was looking through last May's postings to try and find the one about moms, I realized that once again, I'd missed the fact that May is Mental Health Awareness Month. I don't think that's such a good sign, that the psych department doesn't seem to be very aware of this...so, I don't think it's workin', y'all....

Epic-demic

So I'm on call (shocker). And Tyler and I are cruising the ER whiteboard program for crazies, and cracking wise about some of the stupid reasons people come in to the ED. When he suggests the newest impending pandemic -

Manbearpig flu.


I laughed so hard I almost passed out.

(And then I would've had to go to the ER. Can you imagine what that chief complaint would've looked like...do you think they would have taken me cereal?)

Best response ever.

So I get called down to the ER to see this very cute little old lady with worsening dementia, who, fortunately for us (and her, because we have no geropsych beds right now, but we probably will tomorrow) also has a wide complex tachycardia. But, okay, I go down to consult, and know she's had an increase in auditory and visual hallucinations, and so we have the following exchange:

Me: Do you ever hear things that other people don't?

Cute old lady: Well, I hear this man singing in my ear. Only one person, and it's very faint.

Me: Oh, okay. Tell me, do you ever see things that don't make sense, or that maybe your husband doesn't see?

Cute old lady: Tomorrow.

(silence)

Me: Um...tomorrow?

Cute old lady: Yes. Honey, it's 2:00 in the morning. I'll tell you about it tomorrow.

I told her that was the best answer I'd ever gotten to that question. But I still made her tell me about the people she sees on her farm...

Call-ful thinking

Dear Triangle Area Crazy People:

Please stop coming into our ER tonight. We have no more psych beds, and the doctors are tired and want to go to sleep. I've heard, though, that if you go to that other hospital (you know, the one down the street. They're a slightly darker shade of blue than we are) they have wide screen TVs in all the patient rooms and super comfy mattresses and gourmet food and they sing you to sleep at night.

No, really.

Think about it.

Why would anyone want to come here? Last year, one of Ruthie's patients kept finding lice in her bed. I mean, no one else could find the lice in her bed, and they kind of went away when we finally got her meds right, but really, why risk it?

Sincerely,

The Baby Blue Call Team

Hungry

So here's my call story for the evening...it's been a rough day, actually; we've been crazy busy and I got a whole pile of bullshit consults, including one on OB to evaluate a woman for postpartum psychosis, which it turned out she did not have an in fact her only problem was that she was KOREAN and thus spoke KOREAN. Not English. So, you know, they didn't explain anything to her and then decided she was freaking out and psychotic when she was running around with blood on her arm (she pulled out her IV) babbling in...wait for it...Korean. I also had a patient try to leave the hospital (he almost made it) when I came by to tell him that I was trying NOT to commit him.

But anyway.

So, Guido, my intern, and I decide we're hungry and we're going to order dinner. And there's this great service around here that, you order online from one of like twenty restaurants in the area, and they pick it up and bring it to you. For a fee, of course, but you can pay with your hospital meal credit that we get for taking call and let me tell you, it rocks. Okay. So Guido and I order around 7. Usually it takes around an hour, so when dinner wasn't here by 8:30 I called them. And the kid that answered was like, wow, yeah, sorry, we're really backed up tonight, some stuff happened, lemme call the driver, blah, blah, blah. So she shows up about half an hour later, looking frazzled, and we tip her in quarters (neither of us had real cash, but, college kids like quarters, right?) and get our dinner and we are happy campers. Well, at least we've stopped being hungry.

But shortly after that, I get called to evaluate this college kid in the ER, right, who's complaining of "confusion" (as I was telling the kids story to my attending, he stops me and says, "Wait. She's a pothead, right? She sounds like a pothead." That...well, really says it all). And it turns out that what prompted this kid to come in was, she went to work tonight - guess where - and "kind of forgot I was supposed to be at work." Which ultimately translated into this: she went to pick up an order, then promptly went home and ate it. Her boyfriend walks into the kitchen and is like, wait, why are you home, and what are you eating?

Fortunately, it turns out that it wasn't, in fact, our dinner that she was eating.

Sweet kid. Really delightful family. Needs to cut back on the weed.....

Tonight's bit of folksy, on-call wisdom

Growing pot in your closet does NOT constitute "working in a greenhouse." I don't care how many grow-lights you've got in there...

Oh - and!

Somehow in listing last night's weirdness, I forgot to mention the bulimic who called the crisis line and said he was going to eat himself to death.

No, really. I actually spent a good deal of time considering petitioning him...until he threatened me with Whoppers.

It was a weird day.

Fortunately, Peng showed up for night float and rescued me. I finished my last note, she ordered me to eat dinner (at 11:30, because, whoops, I forgot. Fortunately, girl's got my back). I got to sleep around 1, finally, and got a bit of sleep. I spent most of today running errands - I haven't managed to get the chapter read that I need to present at class tomorrow night, yet, but I did get to Starbucks, then the Lowes Hardware, then the gym, my shrink, the Whole Foods, the PetSmart (my groceries, then Maggie's, as it were), and even hit the Panera for lunch. AND I fixed the flapper on my toilet, so now it's not running through the entire water supply of North Carolina (it's so quiet in here....). And even did some dishes, and made some dinner, and screwed around on Facebook for a while. And still haven't read that chapter I'm supposed to present...but, I think I'm going to bed....

3 reasons my life is weird

Three illustrative examples of what my call day has been like. And, remember, I volunteered to stay overnight tonight, smart girl that I am (I actually don't mind, Cleo sounds really sick)....

1. I had to Google "Kazakhstan" for a note. Because I had a kid from there, and I can't spell it without help. She was great - her parents were concerned for a number of valid reasons, but one of their primary worries was how she always said "I don't care" about everything (she's 14. Duh, she "doesn't care"). Her parents get out of the room, one of the first things she says is, "Okay, I actually do care."

2. I just saw a guy in the ER who came into via police in 4-point hard leather restraints. When I went down to see him, he was down to one point. While he was talking to me, he took the zipper pull off his jeans and proceeded to pick the lock on the last cuff, take it off, and sprawl out on the couch (the inflatable rubber couch in the psych room).

3. I cancelled all my patients for clinic tomorrow, right? So I have a lot of them calling me back leaving messages. I get this one message: "Hi, Doc, I'm feeling better, but I need you to call in a prescription for me, I'm going to run out of my meds tomorrow" etc, etc. Went on for two and a half minutes, never actually identified herself.

Great moments in emergency psychiatry

A few of the more choice things we've heard from the ER psych contingent tonight...

Overheard:
Patient: You're a bitch. I don't want to be here.
RN: Well, sir, you should've thought about that before you started walking around naked in your yard.

A seven year old's mother told one of my colleagues the following:

Mom: I said to my son, that's it! You're too disrespectful! I'm sending you to boarding school. And he says, well, if you do that, I'll kill myself. And so I says, well, I'm going to do it, are you going to kill yourself? And he says, if you do it, I'll kill myself. We went like that for about an hour, and then he had a violent outburst.
Colleague: Which means, what, "a violent outburst"?
Mom: Well, when I tried to slap him in the face, 'cause he was being disrespectful, he grabbed my hands and pushed me back. Like he always does.
Colleague: Okay. Have you considered how this might change if you didn't slap him?
Mom: What? But I needed to slap him, he was being disrespectful!

I had a patient tell me tonight, when I asked if he'd ever had a head injury, "Well, I got hit in the head with some pretty severe rocks as a kid."

A different patient told me, "I done some real illiterate things in my life, but I've never tried to kill myself."

I later got consulted for a patient whom the ER told me had said he wanted to kill himself. Yesterday he had a pretty bad fall and broke several ribs. What he said was, "if this don't stop hurting, I'd rather be dead." I give you a direct excerpt from the consult note I wrote:

When questioned about his statement, the patient vehemently denies suicidal ideation. He says, "I don't want to kill myself. I have too much to live for. I should've been dead several times - I had this accident, and a couple of months ago I got bitten by a poisonous snake." When asked how he felt that he had come "close to death" more than once in the past several months, he replied, "I feel fortunate to be alive. I pray every day and thank God that he let me make it another day, but then, we all have our moments of weakness with our words, don't we?" He states that he definitely feels that he can keep himself safe.

Oh, yeah. Let's make sure the psychiatrists see that one....because the mere mortal ER docs couldn't possibly asses that guy's safety. I mean, come on, if he's going to be all vague and dodgy about it...!!

And the night's barely half over....I'm guessing there's more to come before daylight....

More randomness

Because it's 2am, and I just got this call from the floor...

RN: Ms. Doe needs something to sleep.

Me: Okay, has she taken anything before?

RN: Trazodone. She says it makes her mouth dry. (Patient mumbling in the background) She says she'll wake up and drink water.

Me: Oh...so...is the Trazodone okay, then?

RN: (Confers with patient) She says it makes her mouth dry and she has to wake up and drink water.

Me: Has she ever taken Vistaril?

RN: She's already taken 50 mg of it tonight. Maybe we could give her some Bendaryl? She says she takes Benadryl at home.

Me: No, Vistaril and Benadryl are pretty much the same thing. Has she ever taken Ambien?

RN: (Confers with patient) No. Oh. But, I'm looking at the order, and I can repeat the Vistaril. So I guess I didn't need to call you. Oh, but she wants to use her Artificial Tears. Can you put in an order for that?

At 2am. Artificial tears. Really? Fine, fine, fine....

So I go into the physician order entry software to do that, and search for "artificial tears." And I find this. Look at the first item in the search results on the right:


An artificial nose? .....what? What the hell is that?? I thought we'd pretty much gotten rid of leprosy. Is this what that guy from The Humpty Dance pulled off? And why do you need a new one daily? I, truly, have no earthly idea what this is about. But I have some pretty funny mental images...

::EDIT:: Oh, no wait, it gets better. So I Googled "artificial nose", and I found this article, about the benefits of synthetic snot. I love it.

Doggedly funny

I got the following text message from Sparrow (who's watching the Mags while I'm on call):

Maggie looks so chic in the buff! And appears so much smaller! Maxine was confused, but sniffed her entire body - just to make sure the inside hadn't changed, too.

Cracks. Me. Up.