November 26, 2017

the honest man

Ever since I was a kid, I have attracted stray animals.  Dogs, cats.  Even turtles.  It seems I attract the same types of patients.  Among my colleagues, I have become notorious for being A Black Cloud.  You see, we are a highly superstitious lot.  Even more than athletes.  As one off service resident told me, it was a pleasure working with you but I NEVER want to work with you again.  One of my close friends dreads working with me again towards the end of our residency because they know what is in store.  As I work nights in the hospital and admit new patients from the ER, I hear comments from my day team colleagues who then have to deal with the aftermath of my admits.  Such comments as:

Really?  You had to pick THIS one?
Seriously?  Do you go looking for these?
I hate you so much right now.

Even multiple attendings in clinic have asked me, don't you have any normal patients?  You know, like simple diabetes or high blood pressure.  Regular stuff.

It makes me laugh inside.  Sometimes, one laughs to keep from crying.  What else can one do?  But I continue to accumulate my menagerie of strays.  As time has passed, though, I do not simply inherently attract disasters, though I do seem to do that.  Patients share their disasters with me.  For whatever reason.  They tell me things.  They tell me things they have never told anyone else.  Honesty, has tattooed itself all over my face and patients feel comfortable telling me things that they have not told anyone.  I have accepted that role and embraced it.

November 10, 2017

i am the brute squad

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.

Some people never go crazy. What truly horrible lives they must lead.

- Charles Bukowski

"Am I going to have a call a Code Green?" the charge nurse asked, referring to a psychiatric emergency.

"Don't call a Code Green.  Call me.  I am the Code Green."  She smirked and agreed to put the patient on the floor against her better judgment as I gave her both my hospital phone number and cell phone.  My bravado, my swagger, and my humor helped sway her.

My junior resident asked me, "should I be talking to the charge nurse?"  Huh?  I was confused by the question.  But then it became clear with one statement.  "Well, I've just never seen one of my uppers talking to the charge nurse."  Seriously?  I then explain how 90% of being a good doc is simply giving a shit and getting stuff done, which means talking to all the people that get shit done. It's a lot of work but in the end, it matters.  Remember your humanity, I tell them.

This patient had been sitting in the ER for six days.  SIX days.  I was looking for admissions and the ER attending didn't sugar coat it.  I had paid my dues in the ER and earned their respect so was treated as one of their own.  The patient had broken their elbow, had surgery with pins placed which were extruding from the skin.  One pin was missing, though.  Oh, raising my eyebrow.  The patient had removed one pin by their self.  And then proceeded to attack what they thought were demons present.  So now the patient sat in the ER pending transfer to a psychiatric hospital but no one would take the patient with one extra weapon in the elbow just waiting to be unscrewed.  My junior resident looked at me as if to say, you're joking.  No wait, you're crazy.  Indeed.  I smiled back and tell the ER that we will take the patient.  Fast forward a few days of heavy duty psychiatric medications, including an episode of me, in fact, functioning as a Code Green.  Today, orthopedics removed the remaining weapon, aka pin, and the patient is pending transfer to a psychiatric hospital, without a built in weapon.  My Texas bourbon tastes extra good today.