The Wards – Day 2

Yesterday signaled the change in the rotation block for residents and now I find myself on the wards, the most painful of all the rotations in residency. (These days, it even topples the mighty ICU). I figured it might help me get through it if I keep a running diary. This entry is very quick as I’m exhausted. Enjoy.

Call day

My day at work, Tuesday, Feb 10th, 2004:

Alarm goes off at 4:45 – I finally get out of bed at 5:15 am. Wet hair and comb it because I showered last night. Eat some oatmeal and out the door by 5:40. Arrive at work at 6:15 am. (Listened to “Paul’s Boutique” on the drive in). At 6:45 the entire team (myself, two interns, one medical student, one nurse practitioner, and the attending physician) all meet to accept the patients admitted overnight by the “night float” resident. There are six of them. Ugh. They combine to my team of 8 patients already and form a super team of 14 patients. We hear their stories for 45 minutes. At 7:30 am we divide up and go see the patients.

The “On call” pager is handed to me from the night float after check-out rounds. It goes off immediately. The ER. I take an intern and go see the newest patient with her. The rest of the team scatters to get work done. The lady in the ER is a mess. She has intractable nausea and vomiting as well as left sided abdominal pain. Her past medical history is chock full of crap. She takes over 20 medicines daily. Her CT scan shows inflammation in the descending colon (aka large intestine). She’s probably infected. We make a game plan, do serious paperwork and admit her to our team. The intern calls the bed manager to reserve a bed. 15 patients. Its 8:30 am.

That intern and I split up do some more work. I go see a patient on a different floor, one of the ones admitted the night before. He is stable. I go to a different floor and see a different patient. He’s ready to go home. I do some paperwork and make about 6 phone calls. I clear the decision with my staff. He gets discharged. 14 patients. 9:30 am

I go see a few more patients. Put out some fires. Nothing too serious. I’m trying to learn all the patients from last night and “eyeball” them. Surprisingly the pager hasn’t gone off in a while. Its 10:30 am. The team meets for rounds again. A plan comes together for most of the patients. The team scatters to do more work. The pager goes off. The ER again with another patient. 11:45 am

I take the initial intern down again and we see the new patient, eating a quick sandwich on the way. He was discharged 4 days ago from a different team. He went home and got worse. He has congestive heart failure. He isn’t breathing very well. His legs are ridiculously swollen. The swelling is in his scrotum as well. We talk to him about “code status”. He wants no resuscitative measures. We outline a treatment plan and do the necessary paperwork. He’s coming in. 15 patients. I leave and go see a different patient upstairs. 12:30 pm.

The pager goes off again. It’s the ER (fuck!). I take the other intern and go see this new guy. He was called in because the radiologist found a blood clot in his leg and his lung after a recent CT scan was done looking for something completely different. He needs anticoagulation, but it can be done as an outpatient. It takes some convincing for the ER to see it this way. But this guy is not sick and does not need to come in. This kind of thing can be treated at home, when someone is this stable. I do some paperwork. Make about 15 more calls. Go talk to the radiologist and look at the CT scans with him. This clot is old news, after we looked at an older scan. He gets to go home. In the middle of that, the pager goes off again. The clinic. I sent my intern to go see the new one while I finish up the guy with the blood clot. 2:15 pm.

After wrapping up his follow up paper-work and putting his meds in the computer, I run down to the clinic. The pager goes off. Some long distance number. I call it and its Whidbey island naval base wanting to transfer a patient. Crap. A truck driver with inflammatory bowel disease having a severe exacerbation. This isn’t fun for anyone involved. I arrange for him to get a bed at our hospital. I clal the naval base back. The helicopter is on the way. 16 patients. 4:00 pm

In the clinic, the lady from the other call is a huge woman with diabetes and some nausea, vomiting and diarrhea. She’s probably infected too. Crap. I spend some time explaining her what I think is going on. The intern starts the paperwork. She’ll be coming in for antibiotics and IV fluids. 17 patients. 4:45 pm.

The pager goes off. The ER (FUCK!!). An old lady has pneumonia. The work up isn’t complete, but she’ll “probably need admission” – they will page back later. I start looking up her computer records. 5:30 pm.

The team meets again. We round for an hour and finalize the day’s plan on everyone. One other patient was discharged by an intern. Another was taken over by the surgery team to get their gall bladder removed. 15 patients. 6:40 pm

We’re officially off the clock and the night resident arrives. The pneumonia lady will go to him. I spend another 2 hours scrambling around finishing paper work and writing orders. Everyone’s tucked in for the night. 8:45 pm 15 patients.

I leave the hospital and drive home. Check email. Check club. Check blogs. Write this. I’m tired, sorry its so scattered and slangy. I have to get up at 5:00 am and go back. Friday is the next call day. It will be like this, only I will stay overnight and admit patients for an additional 12 hours until 7 am the next day. Not fun. Ah, the wards.
10:23 pm