Only a couple of possible outcomes

When every shift ends, you think to yourself - Did I actually do something? Most of the time, the answer is... 'sorta'. I sorta helped. Of course the attendings did something, residents a bit less, but them too, so maybe it's not a discontinuity when you get to the med student - Maybe I did something too.

But this always happens. When you do a thorough H&P, plucking every flower from the crannied wall, a few things can happen

1. Grunt - Patient grunts, you get along with your day and start thinking about the A&P. 
2. "Ok thank you" - Get along with your day, start thinking about the A&P. 
3. "Thanks doc" - Sometimes I let this slide, especially if it's a combative patient refusing blood draws; I may need to come back later with the nurse and throw down the short coat hammer.* But sometimes I correct them.

"Not a doctor, not yet." Some of them then say "ok." Others say "Oh.. nurse, then?" Haha. A few (and just a few) tell me "You're a doctor to me.."

Always important to end correctly and on a high note. 

Finally I recently had a patient with increased white count and vague abdominal pain (per nurse). When I went to go assess him, he didn't want to talk about his abdominal pain (non existent). The first thing he says is "My uterus is giving out."

In the back of the ER, were beds are 1ft from each other, about a dozen patients chuckled. I mostly held it in and looked to see if he had an adam's apple. He did. 

*In possibly the longest aside ever, on my last day of Transplant, there was a patient who didn't have morning labs. The assumption? Patient is leaving. A shitty way to draw conclusions but it happens. 

When I got around to his floor, he was still there. He had refused morning labs. And noon labs. I talked to him. He wanted two pillows and a blanket. I got him two pillows and a blanket (and is it just me or does everyone look at me funny when I ask where the linen cart is?). I made him compare his hand with mine (he was jaundiced like a diseased frog), asked him whether he thought that was off. "It's off." So can we get some blood to find out why? "Ok let's do it." Told the nurse to page the incoming student if there were more problems. Boom. Ending Transplant like a bawss. 

How to have a successful call

A guide for MSs.

I just finished a month of MICU (awesome) and 2 weeks of Transplant. Here's what I got. Night call is a terrible, terrible beast to be conquered but it's possible - dare I say.. easy? Follow these steps (in no particular order).

1. Workstation - Regardless of which hospital you're at, you better have a place where you can access all the records and labs for every patient you are monitoring, with a phone nearby. This sounds stupid but when I was on Transplant at SLEH/TCH, I didn't have TCH access to certain areas (nor EPIC access) mostly because I didn't have the time to sit through a 6 hour training for something I already knew how to use. So I had to bounce around a lot, let my upper levels log in. BT-MICU was simpler.

Primary recommendation - Find a computer, claim it (easily done if you clutter the workstation with your own crap) and hack away. Don't let anyone near it 'til the morn.


2. Food - gfy, I'm not a fatty, this is important. Bring food from home. Is it just me or did the interns stay much less than MSs when they were on night call? MS on night call means - still have to show up that morning (~6am) and leave the next day with the intern (~10am). Holla, 29 hours. How much food did you bring? Probably ate it all by lunch time, huh? I've done that. Best to just bring in a bag of stuff, like you just came from Kroger and it's your stash for the week.

Primary recommendation - Say... 5 sandwiches, 4-5 yogurt cups, 5 granola bars, possibly some powdered gatorade and whatever else you need (see #3) per 24 hours.
Secondary recommendation - Blow your life savings at McDonalds and pine afterwards at your grossly inflated food expenditures.

3. Coffee - Doesn't work on some people, doesn't work on me. However, with the abundance of free coffee and espresso and cappucchino at TCH, I became a junkie. I was lucky that they had the french vanilla creamer almost everywhere, but just in case they didn't (SLEH does not, just regular creamer*), I had a ziploc back full of my french vanilla elixir to make my coffee palatable.**

Primary recommendation - Just hit it repeatedly. It's not going to work after 2-3 days of abuse anyway and it has other effects, which brings me to..

4. Self-fucking-care - Does this mean daily exercise? No, although that's ideal (and possible). After about 16 hours of being awake, I'm not necessarily slower, but clumsier and start taking shortcuts.. Once after leaving the OR at 11 I flung my arm like a rabid orangutan into the wall panel door switch/plate and a small screw on the plate took a clean chunk right out of my index finger. I should have moonwalked back into the OR main desk and slapped on some tegaderm for some overkill wound protection but I ended up coddling and nursing it instead and wondering when the granulation tissue would appear.

Primary recommendation - Bandaids, listerine (because although you may end up looking like warpig after a while, at least have that minty cool breath), ibuprofen
Secondary recommendation - Not being a dumbass.

5. Clothing - This could fall under self-fucking-care, but it deserves its own category. My body is used to dropping the temp at night. Hell, I still sleep with covers on, in the middle of Houston. Bring extra clothing. This does not mean your whitecoat. Bring a real coat. This was a long time ago, but on OB L&D nights, after the first night, I came with a jacket, sweater, scrub top, tshirt and definitely had all 4 on at one point. Feels good, man. On MICU night call, because I have Alzheimer's and forgot to bring extra clothing, I was hitting up all the blankets I could find. Thankfully MICU has its own linen cart to pilfer from. Figure something out. Jeans under scrubs (seen it / done it). Hoodie like Eminem, all the time, even when seeing patients (seen it).

Primary recommendation - Extra clothes
Secondary recommendation - Linen cart. Find it, use it.

6. Rest - Good thing we just covered warmth and food and self-care so you're not bleeding because if you've taken care of everything, you'll feel tired. Find 10 minutes to wig out, and wig out. That's all. Just do it. Don't make it excessive or anything. On MICU, I used to set a timer for 15 minutes, put my head down and once the timer was up, go around and see all the patients and make light conversation with them*** if they were awake. This is also where #1 is important, for if you've claimed a good spot, you can wig out there. I do not recommend finding a bed, you will be in it for hours.

Primary recommendation - Take some time off. Very few ways around this.

*Regular, unflavoured half and half? What kind of plebian horseshit is that?
**And by coffee I mean, cream and sugar, with a little bit of coffee to taste.
***Hospital TV is atrocious.