MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'float'. Sat, 03 Sep 2011 02:33:27 +0100 http://www.medworm.com/index.php?rid=3542546&cid=t_357742_87_f&fid=34872&url=http%3A%2F%2Fblisstree.com%2Ffeel%2Fhealth-and-beauty-treatment-10-spas-where-you-can-float%2F Image courtesy of Tranquility Floatation, Massage & Healing Center What the hell is floating? (a.k.a. REST, Restricted Environmental Stimulation Technique) Think 800 pounds (!) of Epsom salt dissolved into 10 inches of water in a fancy, enclosed bathtub, or an actual flotation tank (typically eight feet long, four feet wide, and four feet high, or higher) that looks like something you’d find on the planet Krypton. Basically, the idea is that the salt is so powerful that it relaxes you and sucks all the toxins out of your body. I’ve floated a lot in my day, and I hate to admit it (because the costs can add up), but it kind of works. And if you like taking baths, you’ll love floating. (And if you really get hooked, you can install one in your house!) You float on your b... Healthbolt blogs http://www.medworm.com/rss/comments.php?id=3542546 Fri, 07 May 2010 00:00:22 +0100 3542546 http://www.medworm.com/index.php?rid=3035867&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F11%2F28%2Flost-in-the-fog%2F This will tell you what my nights have been like lately: I woke up in the evening to go in for the next shift, and my shoulders were really sore. I couldn’t figure out why. I’d been trying to study a little more, but surely I hadn’t spent so much time hunched over a book to hurt that badly. I was at the hospital for half an hour before I remembered that I’d been doing chest compressions the night before. 1am in the ER, one of the ER residents asked about a patient we’d admitted at 7pm. I couldn’t even remember who they were talking about. A MICU resident asked, How did that laparotomy from earlier in the week do? I said, Which one? The 80yr old with diabetes, the 60yr old with cirrhosis, or the 70yr old who’d arrested? Doesn’t matter, they al... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=3035867 Sat, 28 Nov 2009 12:21:42 +0100 3035867 http://www.medworm.com/index.php?rid=3008029&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F11%2F19%2Fbait-and-switch%2F Half of the general surgery attendings at my hospital will do appendectomies laparoscopically. The other half routinely do them open, arguing that it’s faster and requires less equipment (and is thus less frustrating than trying to get techs trained mainly on ortho equipment to get right in the middle of the night), and that a 2cm open scar is no more painful or unsightly than three 0.5-1cm port sites. My problem is that, after two and a half years, I still can’t remember which half is which. Thus, when I’m explaining to patients – you have appendicitis, you should have surgery tonight, I’ll call my boss and set it up – I usually give them the wrong spiel. Whether that laparoscopy is quick and easy, or that an open incision is quick and easy –  I ... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=3008029 Thu, 19 Nov 2009 14:12:03 +0100 3008029 http://www.medworm.com/index.php?rid=2967236&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F11%2F06%2Felectricity-is-good-for-the-heart%2F More codes last night. That makes the intern happy; she still thinks it’s a game. Which is all well and good, but I’m the one running the code, and I don’t think it’s quite so much fun any more. In a way, yes. It’s the nice that the nurses say, “Oh Dr. Alice, it’s great that you’re here. This isn’t your patient, is it? What do you want us to do?” Um, you’re doing good compressions, and I see we’re ventilating nicely, and you paged anesthesia to intubate (that’s how it’s done at my hospital). (These nurses are good. I much prefer codes in the ICU.) How about finding the doctors whose patient it really is? Because I’m getting tired of running codes that I’m not even responsible for. The medical pe... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=2967236 Fri, 06 Nov 2009 14:50:55 +0100 2967236 http://www.medworm.com/index.php?rid=2963038&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F11%2F05%2Fso-far-so-good-2%2F Not so bad for nights so far. Not much luck at making people come in to operate in the middle of the night, but no one but adrenaline junkies like me and the night float interns really mind that. Speaking of adrenaline: somebody was messing the code pagers tonight. There was one real one, early on, at which I practiced not touching and not talking while the intern did the line (harder than you’d think), and verified that after working on three-hour long resuscitations on open-chest patients in the cardiac ICU, I no longer care very much what particular order the code drugs are pushed in. Epi; bicarb; calcium; is there a pulse? it must have been three or five minutes; more epi. . . And never let the fact that you got pulses once after CPR delude you into thinking that the pulses will ... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=2963038 Thu, 05 Nov 2009 12:00:36 +0100 2963038 http://www.medworm.com/index.php?rid=2660739&cid=t_357742_93_f&fid=35707&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHemodynamics%2F%7E3%2FJVPf4jBdRds%2Fnight-float.html Our department chair decided at some point that the people on night float shifts--interns who cover the medicine patients overnight, and residents who admit new patients coming in after the regular teams have stopped admitting--should have a teaching session. And so we met this morning, all the night float residents and interns. I've been doing a pinch hitter sort of job, in which I do overnight medicine consults and also support the night float interns; next week I'll be doing admissions. The relationship among all of these people is an odd one. Except for me (because I spend a reasonable amount of time checking in with my early-in-the-year interns and backing them up in various medical crises), we are mostly working alone. But we see each other through the night, crossing paths in the ha... hemodynamics blogs http://www.medworm.com/rss/comments.php?id=2660739 Sat, 01 Aug 2009 06:35:00 +0100 2660739 http://www.medworm.com/index.php?rid=2570296&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F07%2F01%2Ffirst-day-of-third-year%2F In one day, I managed to get two people in the unit I started working in to hug me; got one person to yell at me; got three attendings to call me by my first name without reminders; and put in two Swans (as much as in the previous year together). If I can get these to balance out, the next month might not be too bad. (Although I was starting to get that uncomfortable vibe that becomes so familiar to residents, where on the first day of the month all of the attendings claim to be delighted to have you around, and foretell plenty of hands-on learning, whereas within a few days it becomes obvious that you’re still only a scut monkey.) Yesterday I also had the biggest fight I’ve ever had with a nurse. Previously, when people say I don’t get along with nurses, I’ve been ... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=2570296 Wed, 01 Jul 2009 23:31:36 +0100 2570296 http://www.medworm.com/index.php?rid=2550201&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F06%2F28%2Fnot-just-in-the-books%2F I had a very puzzling experience last night. The arrest pager went off, and I happened to be just one floor above, so I got there a good deal faster than most of the rest of the response team, several floors below. So when I arrived, it was just a few of the floor nurses and an aide. One was making a respectable (although to my mind not very successful) attempt at bagging. Another was doing compressions, and stopping every few seconds to look at the monitor. To me, the monitor looked like torsades immediately, the only time I’ve ever seen that rhythm in real life. Finding myself the only doctor on the scene willing to talk (the interns had a deer-in-the-headlights look), I announced, “That looks like torsades. It’s a shockable rhythm. Where’s the defibrillator?&#822... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=2550201 Sun, 28 Jun 2009 06:00:07 +0100 2550201 http://www.medworm.com/index.php?rid=2510065&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F06%2F22%2Fhindsight%2F Most of the residents on call that night were women, and it was a very bad night, multiple disasters at the same time. Towards morning, a couple of us were standing in the hallway, in between ICU errands, propping up the walls and playing one-up: whose disaster was the worst. One of the older nurses walked by, one of my favorites (her name and her face remind me of one of my aunts); she saw how tired we were. “You doctors don’t get enough credit,” she said. We figured she had to be joking – what nurse would say that out loud to residents? but she went on. “It takes some special drive to do what you do. We nurses complain sometimes, but when was the last time any of you worked a 40 hour week?” We nodded slowly, realizing that she was serious. “When ... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=2510065 Mon, 22 Jun 2009 12:46:03 +0100 2510065 http://www.medworm.com/index.php?rid=2510066&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F06%2F19%2Fmidnight-special%2F  Night shift is like a nonstop final exam. Remember how waiting for the test score was sometimes harder than studying for the test? Nights is a series of problem-solving exercises, where you have to come up with your best explanation and plan, then leave the building. You come back twelve hours later, and like it or not, the answer is up in public view. The rest of the residents and attendings on that service have had all day to think about it, and the official position is out: you got it right, or you missed this or that diagnosis or test or medication, and everyone knows.   I need a handbook, something like “Medical Spanish for Dummies,” maybe “How to Break Bad News in Three Easy Steps.” Last night was the worst test ever: a CT scan so bad I had to look at it th... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=2510066 Fri, 19 Jun 2009 13:06:14 +0100 2510066 http://www.medworm.com/index.php?rid=2510067&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F06%2F16%2Frelativity%2F Finally, I’ve figured what is so fatiguing about night float. The shift is only 12 hours, so we actually spend less time in the hospital per day this way than usual. But no matter how hard I try to believe that it’s a normal day (at night), it’s impossible to completely ignore the fact that I spend two days in the hospital, but go back each evening on the same day that I started. So I spend less than a day at home, and two days at the hospital. . . or something like that. Anyway, overnight feels like a longer, more significant length of time than a day. Plus, of course, the inevitable 2am disaster; I can almost set my clock by this one, and usually from the same floor (admittedly the busiest surgery floor, so it’s not really their fault). The only question is how bi... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=2510067 Tue, 16 Jun 2009 14:37:35 +0100 2510067 http://www.medworm.com/index.php?rid=2457990&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F06%2F06%2Fnight-in-the-icu%2F I didn’t want to ask for help because it would be a confession of weakness. But my patient was dying, really dying, all of a sudden, out of nowhere, and I didn’t know why, and I didn’t seem able to do anything to stop him. I figured it would be even worse if he died because I didn’t ask for help. So I did. I don’t know what’s worse, that I was weak enough to ask, or that the person I asked didn’t really know any more than I did, and didn’t do any more than what I was about to do anyway. The patient survived, mostly thanks to the nurses, and due to what they and I did before the help arrived. I guess it’s good, in a way. I’ve proven to myself that I can get through anything (with the right nurses). I need to stop using the comfort ... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=2457990 Sat, 06 Jun 2009 22:29:52 +0100 2457990 http://www.medworm.com/index.php?rid=2386870&cid=t_357742_93_f&fid=35707&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHemodynamics%2F%7E3%2FfWu1_fAXQOQ%2Fnightfloat-pictures-from-my-phone.html From a few weeks ago when I was working nightfloat...From top to bottom:the hospital at nighthallwaysand a sign put outside the rooms of patients on fall precautions. (Source: hemodynamics) hemodynamics blogs http://www.medworm.com/rss/comments.php?id=2386870 Mon, 04 May 2009 02:05:00 +0100 2386870 http://www.medworm.com/index.php?rid=2304578&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F03%2F31%2Fplus-and-minus%2F No matter how much trouble I have with a rotation, I always get nostalgic for it during the last few days, and uneasy about leaving to do something different. Strangely enough, I feel the same way about night float, the rotation that everyone in the program loves to hate. Despite the difficulties of switching your schedule around by twelve hours, to the exact opposite of everyone else’s, and then having to stay awake for conference on odd days (and in my case, wake up for church on Sunday), night float has its benefits. We own the night. There’s a sense of empowerment in surviving the worst rotation of the residency (and having nearly all of my patients survive it, too). If I can do this - since I have done this - I can do anything. (So, ok, every one of the chiefs was more tha... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=2304578 Tue, 31 Mar 2009 13:30:24 +0100 2304578 http://www.medworm.com/index.php?rid=2304580&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F03%2F27%2Fmedical-calculus%2F Night time is all about triage. When you get three pages exactly at the same time, which one do you answer first? Two interns calling you, who do you answer first? Two consults in the ER, which one to see first? Two attendings to call, which one goes first? More complicated: An admission in the ER, and an ICU consult which is probably nothing - but you won’t know for sure till you look for yourself. A floor consult which probably needs surgery, and an ER admission which probably doesn’t need surgery - again, nothing for sure. An ER consult which needs surgery, and an ICU patient with a pressure of 60/40 and no lines. Sometimes, like the ICU patient whose vital signs are not compatible with long-term survival, it’s easy to figure out where to go first; and the attending wi... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=2304580 Fri, 27 Mar 2009 12:27:30 +0100 2304580 http://www.medworm.com/index.php?rid=2304582&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F03%2F26%2Ffull-circle-3%2F Sorry for the shortage of posts. Night float doesn’t leave a lot of energy for talking. Last year I was in awe of the junior residents on call. So much responsibility, and they handled it so coolly. Sometimes I saw the stress, but they covered it pretty well. I wanted to be like them. And here I am now; I don’t think I’m as cool as they were. In fact, I can see it, when there are senior residents around at night for other things; they look at me out of the corner of their eye. I’m not doing anything exactly wrong, not wrong enough to be stopped; but I’m more excited/nervous/antsy about all of this than the guys ever let on. (I’m upset that my patients get sick, become permanently handicapped, die, and I can’t stop it; I don’t know how not to ... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=2304582 Thu, 26 Mar 2009 14:22:29 +0100 2304582 http://www.medworm.com/index.php?rid=2269962&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2009%2F03%2F14%2Fin-summary%2F The week was fairly quiet: only a few cases to go to the OR at night, no remarkable activity in the ICU, no dramatic traumas. I was figuring that my white cloud had stuck with me; and indeed it was remarkable how all the arrests on the floor, and all the gunshot wounds for trauma (which it’s part of my responsibility at night to assist with) should all happen during the daytime for a solid week. Of course Friday night that all changed, and I was completely swamped, to the extent of almost recklessly leaving things unfinished with one patient in order to hurry off to the next, leaving large jobs for the interns to do alone that normally I would help with, and being quite curt in my discussions with patients (completely contrary to the rules of don’t interrupt, and don’t as... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=2269962 Sun, 15 Mar 2009 02:42:37 +0100 2269962 http://www.medworm.com/index.php?rid=1671614&cid=t_357742_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2008%2F07%2Fnightfloaters-prayer.html Mincha with tallis and tefillin. (Source: Zackary Sholem Berger) Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=1671614 Thu, 31 Jul 2008 22:13:00 +0100 1671614 http://www.medworm.com/index.php?rid=1552254&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F06%2F26%2Fa-little-backwards%2F I’ve been reading some of the never-ending controversy in the medical blogosphere about the 80-hr week (some are talking about 57hrs as though it’s a definite development; that had just better not be true). I thought I’d add a slightly different perspective: Today I worked about 14 hrs - came in an hour earlier than I was supposed to, and left an hour later than I was supposed to; not bad for a surgery intern. At the end, I walked away from a sick patient who will likely to go the OR tonight, I’d guess around midnight. When I left, he wasn’t acutely decompensating; his pressure had stabilized and he didn’t need to be intubated, yet, although there were more lines being put in. I had admitted him; he was one of the traumas that came in all together, and... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1552254 Fri, 27 Jun 2008 01:21:52 +0100 1552254 http://www.medworm.com/index.php?rid=1443128&cid=t_357742_93_f&fid=35707&url=http%3A%2F%2Fhemodynamics.blogspot.com%2F2008%2F05%2Fadvance-by-day-maintain-by-night.html If hospitals finally designed truly rational production processes and became 24 hour enterprises, care might work better and be safer--but where would the romance of the night shift be?I'm quoted today in White Coat Notes, a brief quote in which I say that in the hospital "We maintain by night and advance by day", which might be worth explaining a bit more.The hospital is a constant production process. But it's in transition: it inherits many of the features of its pre-industrial roots. A truly efficient production process never stops, but the hospital slows down considerably at night. I think there would be a lot to be said for a truly 24-hour hospital. But that would require more health care workers, more money to pay people extra to work overnight, and a completely different way of arra... hemodynamics blogs http://www.medworm.com/rss/comments.php?id=1443128 Wed, 14 May 2008 23:14:00 +0100 1443128 http://www.medworm.com/index.php?rid=1344813&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F04%2F01%2Fwild-ride%2F My plan for the last night of March was to keep things quiet, get some sleep, and study up for a laparoscopic procedure that I had been semi-promised on my new service the next day. Semi-promised, as in, “X procedure. . . you do know how to do that, right? [alarmed] Have you ever done one of those?” Me: “Oh yes, sure - at least, I did one.” So every time the junior residents saw me, they egged me on to make sure I did the case, and every time the chiefs saw me, they expressed skepticism over the wisdom of the plan, coming off of nights, a complicated patient, and so on, and reassured me that one of them could do it if I couldn’t. Needless to say, after a very few of these conversations, I was quite determined to do the case no matter how tired I was. After all... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1344813 Wed, 02 Apr 2008 00:07:38 +0100 1344813 http://www.medworm.com/index.php?rid=1338382&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F31%2Fplanning-ahead-2%2F I spent a large part of the night, in my capacity as plastic surgery consultant, watching the trauma team and the neurosurgeons handle a stream of disasters. I would get a perfunctory consult, because of a broken orbit or zygomatic arch, or maybe a few small lacerations, but I wasn’t about to take up the time to look at the patient or sew things neatly while the neurosurgeons were discussing how fast they could get the subdural or epidural hematoma into the OR. Then there was the poor guy who came in with his face streaming blood and an unstable airway which took the longest time to get control of. I stayed around, because I figured with his face looking like that, there would be a plastic surgery consult forthcoming. When we finally got to the CT, everyone was amazed to see that the... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1338382 Mon, 31 Mar 2008 11:42:27 +0100 1338382 http://www.medworm.com/index.php?rid=1335498&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F29%2Flife-is-good%2F Jesus, I am so grateful to be doing this. Answering pages tonight, I was just happy that I get to be answering pages about surgery patients. In general, I am interested in what’s happening with them, and I’m familiar enough with most surgical situations to be able to give glib answers to questions. I am glad I get to take care of surgery patients. Life is good. And then, of course, I get to sew people up, too. I had a guy with the most complicated facial lacerations I’ve seen yet. It took me an hour and a half to finish. I think I did the best possible job with them. As messy as they were, he’s not going to be pretty, but hopefully not too horrible either. I bit my tongue and managed not to console him with the observation that scars look good on guys. He was the ni... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1335498 Sat, 29 Mar 2008 12:26:50 +0100 1335498 http://www.medworm.com/index.php?rid=1332930&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F28%2Fhyperinformation%2F Finally, a quiet night. I kept getting pleasantly surprised when I answered my pager: “Oh, sorry, wrong person.” “Can so-and-so have tylenol?” “Can so-and-so have ambien?” “Oh, sorry, wrong person.” Some people hate those mistaken identity pages. I don’t. They feel to me like getting a surprise rebate, or a 50% off coupon. I even got to scrub in and assist on a case which went really long (three hours after I got there, and more after I had to leave to take care of some things). The attending, whom I hadn’t worked with before, was polite to the assistants, funny, and kept explaining what he was doing almost nonstop, which was terrific. Some attendings hardly talk at all in surgery, and if you do ask a question, they answer under t... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1332930 Fri, 28 Mar 2008 11:16:41 +0100 1332930 http://www.medworm.com/index.php?rid=1330068&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F27%2Ftreadmill%2F I spent all night admitting patients, so much so that I started to feel like part of the hospitalist team - one admission after another. There was one point where I had more than 10% of the ER waiting to be admitted by me individually, plus people already on the floor. At least they were all genuinely sick and deserving admission, which always makes one feel better about it, except that all the attendings were angry at me, for one reason or another, and most declined to answer my pages anywhere near the time I called them. And then I paged them a couple more times, which no doubt didn’t make them any happier. But since I’m sure they were at home either getting ready for bed or in bed, I don’t see why it should take twenty or thirty minutes to call back. Yes. And so on all... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1330068 Thu, 27 Mar 2008 11:13:16 +0100 1330068 http://www.medworm.com/index.php?rid=1327697&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F26%2Fnot-much%2F I have a new favorite set of dumb pages: two nurses apparently were trying to divide their work load, and were taking turns calling to ask me questions about the other’s patient. Then, an hour or two later, the other nurse would call to ask the same question, since apparently the division of labor didn’t extend to passing along the answer. I kid you not, they did this a couple of times last night. Silly me, it seemed simpler to just answer the question again than to get into it farther, so I didn’t say much. I am now officially tired of being on night float. I get to feeling like I’m walking through a valley waiting for ambushes. It’s not so much the patients I’ve been told about - this guy has low urine output, this one will need to be admitted, we&#821... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1327697 Wed, 26 Mar 2008 11:44:42 +0100 1327697 http://www.medworm.com/index.php?rid=1321320&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F22%2Fsorting-it-out%2F That was a busy night. Spent a lot of time shepherding a patient who ended up going back to the OR in the middle of the night. Although too bad for the patient, it was kind of nice to have been right about what needed to happen. Then, it seemed like every drug dealer in the city decided to shoot or stab himself in the hand, and come to our ER to see about it. Such babies. For big guys who were playing with dangerous weapons in dangerous situations, they were pretty wimpy about the results. On the other hand, they were also fairly polite about it, and quite willing to explain all the circumstances surrounding their misadventure. Made the time pass while I was suturing. Maybe surgery residency was like this before the 80hr rule, but we seem to have a very stiff ethic about responsibility for... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1321320 Sat, 22 Mar 2008 11:21:23 +0100 1321320 http://www.medworm.com/index.php?rid=1319706&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F21%2Fer-time%2F Congratulations to all the students who matched this week. Make the most of your time from now till July. My program filled its places with good people, and I’m looking forward to having them around in a few months. If I have to be a junior resident, they will make good interns. I made a new rule last night: no peanut gallery when I’m suturing in the ER. I know, that’s supposed to be a basic ground rule. The last few times I let it slide because the family member was somehow medically informed, and very interested, or because the injury was so traumatizing I felt like the patient needed to have more support than just my chatter during the procedure. However, I draw the line at three rednecks joking about matters while I’m trying to figure out which tiny pieces get c... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1319706 Fri, 21 Mar 2008 10:38:51 +0100 1319706 http://www.medworm.com/index.php?rid=1316891&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F20%2Fworrying-too-much%2F Due to some convolution of hospital politics (of which no one has really informed me; I deduce its occurrence by the effects on me), I find myself covering yet another service, about which I know even less than some others. Talk about sink or swim. Fortunately none of the patients I’ve handled like this have been truly sick yet, although they always come billed as something quite frightening, and it takes a little investigation to assure myself that they’re actually stable. Also the attendings are still new enough at having resident coverage at night that they actually appreciate my calls - unlike some other attendings, who now take us for granted and regard my calls as a nuisance. At one point tonight I found myself wandering into the ICU to check on one of my few patients th... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1316891 Thu, 20 Mar 2008 10:48:31 +0100 1316891 http://www.medworm.com/index.php?rid=1311634&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F18%2Frocky%2F Not a fun night. One of the services I cover did its usual crazy thing, admitting three patients right at sign-out, and spending five hours in the OR with one of them. I’m getting a little tired of working with the intern on this service. He means well, and I don’t think he’s deliberately neglecting things; but it’s getting to the point where I feel I have to double-check every point he tells me in sign-out, otherwise the nurses will be calling me at 2am: “this patient is for the OR today, did you mean him to be NPO?” “this patient just started coumadin, do you perhaps want an INR drawn this morning?” “this patient got a transfusion, would you like to check the hemoglobin count?” “this patient was admitted the other day, wo... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1311634 Tue, 18 Mar 2008 14:01:03 +0100 1311634 http://www.medworm.com/index.php?rid=1307990&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F17%2Fa-night-well-spent%2F It’s amazing how good a solid night of studying makes you feel. I only got paged about urology issues, which are also very satisfying, since they call for a quick, relatively risk-free and painless procedure which makes the patient feel better pretty quickly. So far I’m 30% of the way through The ICU Book (300/1000pp) (and only 3% of the way through The House Officer’s Guide to Urological Emergencies, which perhaps I ought to be reading more of, but somehow it’s not very gripping). I’m starting to have mixed feelings about the book. On one hand, it certainly contains such wildly relevant and fascinating subjects as, five continuous intravenous vasoactive medications (otherwise known as the five pressors, which about half the ICU population are on, and about wh... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1307990 Mon, 17 Mar 2008 10:50:05 +0100 1307990 http://www.medworm.com/index.php?rid=1303588&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F14%2Fa-little-better%2F Last night was slightly better, as in none of my patients crashed, I didn’t have to talk to any of the people involved in last night’s debacle, and that patient continues to do crazy things, but seems to be surviving them. One of his nurses paged me tonight: “Alice! I knew you would call me back. I’ve been calling cardiology and pulmonary, but they don’t answer me.” I guess sometimes reliable is better than - intelligent. I managed, that time, probably because I was more awake than the consultants had been. One of the services I cover is in a permanent state of disarray, so sign-out consists of: these patients had surgery today, those ones are having surgery tomorrow please make sure their papers are in order, I don’t know what these three people ... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1303588 Fri, 14 Mar 2008 12:00:40 +0100 1303588 http://www.medworm.com/index.php?rid=1298079&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F12%2Fi-need-psychotherapy%2F The thing I hate about sleeping in the hospital (and sometimes at home, too) is that I can never tell the difference between pages I really get, and the ones I just dream about. When I’m napping in the call room, I wake myself up every half hour or so (in addition to real pages) by imagining that my pager is going off, and that I’ve talked to someone about some emergency that I need to deal with right away. Then I drift back to sleep, and wake up five minutes later, panicked about having missed something, and trying to remember what the problem is. If I don’t wake up thoroughly at that point, I can spend the rest of the nap fighting subconsciously about that nonexistent page - or sometimes more than one. I even imagine whole conversations with nurses or referring resident... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1298079 Wed, 12 Mar 2008 14:36:05 +0100 1298079 http://www.medworm.com/index.php?rid=1291226&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F10%2Fmangled-hand%2F Just spent nearly the entire night working on the most horrible hand injury I’ve ever seen. I brought some textbooks, planned to study conscientiously all night, got bored, said it too loudly, too many times, and of course got called by the ER. (Note: even more certainly than the taboo against saying “quiet night” is the rule against walking into the ER without having been called; it’s just asking for trouble, and you’ll always get what you ask for. I was going to look for some ivs to start, but instead I got this.) It was messy, nasty, bloody, bits and pieces hanging out all over the place. I didn’t particularly enjoy that part of it, but with the patient and family looking so horrified, it’s not too hard to keep calm, act like you’ve seen i... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1291226 Mon, 10 Mar 2008 10:33:39 +0100 1291226 http://www.medworm.com/index.php?rid=1283742&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F06%2Ftickled%2F I am, I regret to say, quite pleased with myself, which will no doubt get me in big trouble tonight. But for last night, it was great. They finished with a complex and unusual surgery and took the patient back to the ICU. Somehow he was now my responsibility. The attending and resident left to go home to sleep for a few hours, after leaving me with complex and detailed instructions covering most possibilities. Of course, as soon as they were quite out of the building, something else happened. He needed a chest tube, or rather, a pigtail catheter. This matters, because I was fairly sure I could do a chest tube, but I had never before seen a pigtail put in (it’s a much smaller tube for draining only air out of the chest cavity, when you don’t expect to find blood, and thus don&#8... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1283742 Thu, 06 Mar 2008 14:23:12 +0100 1283742 http://www.medworm.com/index.php?rid=1281146&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F05%2Findecision%2F I’m still not doing well with this independent judgment thing. I really hate having to put myself on the line: take responsibility for having gathered all the relevant facts, for having weighed them correctly, and for having chosen the right course of action - without checking with anyone else first. It’s kind of like the difference between practice test questions, when you can look at the answers right away and see how you did, and the real test, where you just have to plunge ahead, and wait a few months to find out whether you were right or wrong. That’s the nature of being a doctor, but after spending eight months accustoming myself to checking everything with a senior, no matter how confident I am, and being chewed out if I fail to do so, this is a little bit of an ad... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1281146 Wed, 05 Mar 2008 13:05:44 +0100 1281146 http://www.medworm.com/index.php?rid=1278593&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F04%2Fscore-one%2F My job description this month calls for a lot of independent assessment, decision making, and interaction with the attendings. Half the time, I have to call very senior staff by myself, no junior resident to run things by first, and I find them making their decision based on my reporting. Apart from burns (where I knew the nurses knew almost everything, and would tell me what they thought needed to be done), this is the first time I’ve had so much responsibility. I spend a lot of time agonizing over whether it’s worth calling the attending with this issue, or whether it can wait; whether I’ll get in more trouble for waking him up at 1am and it turns out to be nothing, or more trouble if I don’t call and then things go bad; whether I’ve gathered absolutely ever... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1278593 Tue, 04 Mar 2008 15:48:22 +0100 1278593 http://www.medworm.com/index.php?rid=1275055&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F03%2F03%2Fhamfisted%2F I found myself in the OR at the beginning of a big case. A rather stupendously big case, to be precise - ten times over my head. But the attending was starting by himself. So I asked: “Would you like another pair of hands?” Sure, he said, scrub in, there’s always room. Back in medical school, I learned the [very] hard way to give warning before trying to do something (close fascia, place a line, etc) that I’d never done before. Sometimes, it seems that I still need to give warning that I’m only an intern. Here, I didn’t. For one thing, I kind of assume that the attendings will recognize which residents have been around the OR a lot, and which ones are relatively new faces. Wrong assumption, apparently. Five minutes in: “Tell me again, what year are... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1275055 Mon, 03 Mar 2008 11:53:05 +0100 1275055 http://www.medworm.com/index.php?rid=1272612&cid=t_357742_93_f&fid=35707&url=http%3A%2F%2Fhemodynamics.blogspot.com%2F2008%2F03%2Fsnapshots-of-va.html For two weeks, I'm on nightfloat at a Veteran's Administration hospital, a dark quiet place at night. ***There's a big photo of the president at the entrance. Each night as I walk in, I think, I hope that photo looks a lot different next year.***There's no cafeteria at night. There is a room full of vending machines. I had a 20 dollar bill and I wanted a Coke Zero. In a quiet hour, I walked down to the emergency department and asked the clerk if there was a cashier anywhere who took payments at night, so I could get change. He sent me to the security desk, staffed by a VA police officer who told me that there was no cashier anywhere, and no change machine he could think of. I thanked him, and started to turn to walk away. "But there's a stamp machine," he said; "You could buy a stamp and i... hemodynamics blogs http://www.medworm.com/rss/comments.php?id=1272612 Sun, 02 Mar 2008 21:22:00 +0100 1272612 http://www.medworm.com/index.php?rid=1263572&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2008%2F02%2F27%2Fdont-run-with-scissors%2F I discovered for the first time today (at least as a doctor) that it is possible to be tired of doing surgery. Of course, the fact that I spent enough time in the OR to reach this conclusion was wonderful. I also hope that when I progress to doing something more than holding one instrument and (this is what distinguishes me from the medical student) having to stay alert enough to agree when the attending says, “Don’t you think this is the right place to cut?” or “I don’t see anything else bleeding, do you?” and so on, I will have more stamina. Today I tried falling asleep again in a dark OR. Fortunately the only thing I was supposed to be doing was holding pressure on something, and since the attending didn’t say anything, I figure I managed to bot... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=1263572 Thu, 28 Feb 2008 01:01:32 +0100 1263572 http://www.medworm.com/index.php?rid=1221313&cid=t_357742_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2008%2F02%2Fdistress-and-disease-inextricable.html The important lesson to be drawn from studies of medical-psychiatric comorbidity is that distress and disease both produce physical symptoms. It is not productive to dichotomize symptoms as "somatogenic" and "psychogenic" because physiologic and psychological processes are involved in all symptom production and perception. "Rule out" diagnostic strategies that search for either a medical or a psychiatric cause of a physical symptom are not supported by epidemiologic findings of high rates of medical and psychiatric comorbidity.-from Katon W, Sullivan M, Walker E. Medical symptoms without identified pathology. Ann Intern Med 2001;134:917.I remember last year when I started the night float rotation; the interns passed around a handout, compiled a few years ago by some previous interns who we... Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=1221313 Sun, 10 Feb 2008 23:22:00 +0100 1221313 http://www.medworm.com/index.php?rid=993500&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F31%2Fhighlights%2F When PEs (pulmonary emboli) get bad enough, even I can see them on the CT scan. That doesn’t mean I appreciate Brad categorizing them that way: “I tell you what, (chief), these things are so big, even Alice here can see them.” Deep breath. On the other hand, when a femoral line on a rather highstrung patient was needed, he announced: “You’re going to get this one right. No other options. I’m not even going to put on gloves.” And he didn’t. He just stood there at the foot of the bed, and refused to say a single thing. It went in beautifully. Of course within a few hours that patient developed renal failure from a medication, so it’s a good thing the line was in, but it kind of ruined the satisfaction of a perfect procedure. (That, and t... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=993500 Wed, 31 Oct 2007 12:38:48 +0100 993500 http://www.medworm.com/index.php?rid=993501&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F31%2Fnightmare%2F The only thing worse than one of your patients trying to die on you is two of them doing it at once. And the only thing worse than that is when three other patients in the same hospital join in at the same time. Five codes in one hour, four of them in 10 minutes. And it’s not even Hallowe’en yet. (Which holiday I hate more than any other American festivity, but it’s hard to ignore, with ghosts hanging all over the hospital ceilings, and spiders and bats and ugly witches popping out of all corners. Hallowe’en is evil, and I want to throw all the decorations in the trash. Thursday morning, that’s what I’ll be doing. . . cleaning house for all my units. . . I wish.) Lately I’ve become paranoid about checking my beeper the instant it goes off, to make... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=993501 Wed, 31 Oct 2007 12:25:13 +0100 993501 http://www.medworm.com/index.php?rid=983437&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F27%2F1-in-100%2F Tonight was absolutely great. I diagnosed a guy with rapid afib (actually the nurse did; the rate was so irregular you only had to feel the pulse for a few seconds to tell, unlike some people, where all you can tell without an EKG is that it’s fast), did the appropriate tests, moved him to a monitored floor and (with Brad’s supervision) organized enough meds to convert him back to sinus. (Which was thrilling to me; I hadn’t actually believed it possible, his rate was so high and variable.) We signed out to the day team: “Your patient went into afib with rapid ventricular response; we started him on a drip and converted his rhythm. You can consult cardiology if you want to, but he’s fixed.” (I’m sure they will put in the consult, for completeness&#... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=983437 Sat, 27 Oct 2007 11:05:18 +0100 983437 http://www.medworm.com/index.php?rid=980754&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F26%2Fthe-dark-side%2F Brad’s version of the established and respected surgery practice of critiquing your juniors rudely in front of a large audience during stressful moments made for a rather unsettling night. At one point I found myself standing outside a room with two nurses (we having all been found fault with, loudly, me most of all). One of them said, “I’m just going to defuse some anger here before going back to my other patients.” I told her, “Then one of us needs to move away, because this cubic foot of air doesn’t have room for all of our anger.” Six hours later, I can tell myself that the attendings speak to the residents this way all the time, in the middle of the OR, during both elective and emergent cases. Seniors to juniors is quite normal, as well, I s... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=980754 Fri, 26 Oct 2007 13:04:25 +0100 980754 http://www.medworm.com/index.php?rid=977496&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F25%2Fstill-here%2F Somebody, somewhere in the hospital, has offended the trauma gods. I think it might be the chief, because whatever service she’s on tends to just get rained on, with crazy admissions, weird procedures, and spectacular complications. The night started off with four traumas on top of each other (which Brad and I only showed up to accidentally, because the pages looked so similar we assumed it was just one patient being announced several times), and progressed in a similar fashion, with at least one call every hour, often two or three at a time. We wound up with a trauma code, which is supposed to mean a patient in really serious condition. This one wasn’t at all, which was kind of the last straw to ruin the chief’s night. After getting all keyed up, for one trauma after ano... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=977496 Thu, 25 Oct 2007 12:58:37 +0100 977496 http://www.medworm.com/index.php?rid=974980&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F24%2Fnocturne%2F We started off the night with another central line, which went pretty smoothly, all things considered. Brad was willing to try a different approach that we hadn’t done before, which made things slightly more tricky, but it went in the right place. Some time later, I got called by one of the medicine attendings: “Your patient just had a code purple [substitution for hospital’s pet phrase for not quite a code, but deserves an emergency response team] called on them for unresponsiveness, I’m up here, and my resident is determining whether they need to be moved to the unit.” There goes one of my nightmares come to life: my patient crashing, and I didn’t know about it. I ran upstairs after paging Brad. Things were under control, and probably could have been h... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=974980 Wed, 24 Oct 2007 12:37:53 +0100 974980 http://www.medworm.com/index.php?rid=972916&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F23%2Fnot-quite-drowned%2F My med student tonight confessed to being a black cloud. It was either that, or my four nights of complaining about inactivity finally boomeranged on me. My beeper went off non-stop, the three-pages-at-a-time way, for the first half of the night, and barely slowed down for the second half. Once again, Brad was similarly tied up in the ICU, so I spent several hours running around, trying not to imitate a chicken with its head cut off, juggling way too many people with chest pain, shortness of breath, tachycardia, fever, and low urine output. (Not all in the same person, thank God.) Partway through, amid a flurry of non-serious trauma pages, a real code came in. I went down to hang out, and the chief waved me in. “You want to do the chest tube?” “I’d love to.” ... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=972916 Tue, 23 Oct 2007 14:37:27 +0100 972916 http://www.medworm.com/index.php?rid=968483&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F22%2Fjump-in-and-swim%2F Sunday night is usually bad. The nurses are disgruntled about working the last shift of the weekend, the residents who were on during the day don’t clean up as neatly as on a weekday, and the patients who were trying to wait out the weekend finally give up and come in to the ER. I spent the first four hours handling situations that had been developing all day. The patient had been short of breath, and finally somebody noticed that they were desatting as well. The patient had been tachycardic, and the nurses decided it was high enough to be worth calling me about. The patient had been febrile all day, and now high enough to need some investigation. And the ICU patients were apparently falling apart just the same, only more so, so Brad was too busy to help me at all. Amazingly enough, ... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=968483 Mon, 22 Oct 2007 10:43:45 +0100 968483 http://www.medworm.com/index.php?rid=965429&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F20%2Frandom-thoughts-at-night%2F As we were in the ER evaluating a patient, we came across an EKG which was rather interesting for its complete normality (in a patient with a list of medical issues as long as your arm). So I started quizzing the student (yet another one of these bright-faced, eager fellows who plans to do surgery) and making him read it in order. I like to force students to go through EKGs neatly (rate, rhythm, P waves, QRS complex, ST segment and T waves) because I had a hard time learning EKGs, and I was halfway through fourth year before some cardiologists impressed on me the importance of reading EKGs in an organized way. By now, I can glance at them and get a gestalt (no afib, no ST/T wave changes suggestive of an MI), but I still have to go through carefully and make sure I’m not missing an AV... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=965429 Sat, 20 Oct 2007 08:54:51 +0100 965429 http://www.medworm.com/index.php?rid=962808&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F19%2Fjust-right%2F I had just settled down to read my critical care articles (another subject about which I could stand to learn a great deal more), and was trying to figure out how to pray for something to happen without intending for anyone to get seriously hurt, when the trauma pager started going off. So far we’ve had three patients, increasing in severity, to the point that Brad stopped scoffing at me for haunting the ER, and came down to see too. But in spite of all this, the patients seem to have surprisingly avoided serious injury. Even with serious mechanisms of injury, nothing horribly irreparable has happened. I haven’t said much about Brad lately, which is kind of unfair, since he’s one of the most important parts of night float. He has some personality quirks; but I owe him a l... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=962808 Fri, 19 Oct 2007 08:24:04 +0100 962808 http://www.medworm.com/index.php?rid=959948&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F18%2Fabsolutely-nothing%2F Let that teach me to regard the residents’ judgment, let alone my own, above the attendings’. My patient was not in the ICU, and indeed looked marginally better than when I left. I guess he probably will survive without surgery. Tonight was extremely boring. It looked good at the beginning, as the most overloaded team ran through their list in signout and discovered a couple of consults that no one had bothered to tell them about (folks, if you think your patient may need surgery, that should be serious enough to warrant you calling the surgeons yourself, rather than waiting three to six hours for the nursing staff to notice the consult order, and get around to paging us). But things tapered off quickly after that. Amazingly, all of the post-op patients were doing well with th... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=959948 Thu, 18 Oct 2007 09:19:28 +0100 959948 http://www.medworm.com/index.php?rid=951026&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F15%2Fmeans-to-the-end%2F I guess I ought to be grateful for the nurses who call to inform that the patient does not have a fever (who have, wonderfully, been fewer in number as the month progresses; not because of anything I do, because my standard response to annoying calls is to say, Thank you very much for telling me; I’m not sure whether it comes out sounding pleasant or annoyed), in light of this recent exchange: Nurse: Do any of this list of patients belong to you? Alice: Well, I cover the general surgery services. Are any of your patients on those? Nurse: Not this one, or this one, or this one. But this guy would like something for sleep. Alice: Okaay. Nurse: And this lady here has had slightly low urine output all day; but it’s picking up now. Alice: That’s nice. Nurse (coming back from t... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=951026 Mon, 15 Oct 2007 12:13:19 +0100 951026 http://www.medworm.com/index.php?rid=951027&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F15%2Flearning%2F (It would help to hit post after writing these things. . . )  The last few nights have really been very quiet. So quiet that I’ve been overcome by a compulsion to study around midnight, instead of taking a nap or reading blogs. There have been enough patients with syndromes I’d never actually seen before that I can learn a fair deal of relevant stuff by just searching their keywords. My students are also getting plenty of sleep, after we see one or two interesting patients, scroll through some CT scans, and run through my stock of three solid pimp questions (primarily, the main causes of postoperative fever; I was rather surprised that no one had asked them these before, since I’ve gotten asked plenty, both in med school and in the last few months; but I guess I didn&#8... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=951027 Mon, 15 Oct 2007 11:39:37 +0100 951027 http://www.medworm.com/index.php?rid=948834&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F08%2Fnothing-much%2F Tonight was amazingly quiet. We admitted one patient of that special genre distinguished by the fact that the ER residents run the other way when they see her name on the list, the nurses fight about who gets to not have her, and when we sign out in the morning, the team lucky enough to have received her says, “Explain to me the difference between her three admissions last month, this admission, and her scheduled admission later this week?” And we can only shake our heads. Sorry, no difference. She picked this night to spend in the ER, that’s all. Neurosurgery had some dramatic head bleed (there I go talking in undistinguished general surgery/ER terminology; I didn’t get a long enough look at the CT to see whether it was epidural or subdural; it needed surgery, eith... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=948834 Mon, 08 Oct 2007 10:51:50 +0100 948834 http://www.medworm.com/index.php?rid=948835&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F06%2Fdata-collection%2F Nothing much really dramatic happened last night. Brad has quizzed me enough when I call him with questions that I’m starting to get the hang of doing a thorough but very fast evaluation before calling him. It’s kind of tricky to know how sick the patient is, and how much time I have to gather how much information before calling. Usually, I think, seeing as I’m on the regular floors, there’s enough time to get all the information: vital signs, pulse ox, urine output, NG output, type of iv fluids and rate they’re running at, and how much pain medicine the patient has received lately (if they’re now delirious) - seem to be the usually pertinent facts. The problem is that the nurses rarely know more than a few of these points, so I have to harass them sligh... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=948835 Sun, 07 Oct 2007 00:00:18 +0100 948835 http://www.medworm.com/index.php?rid=948836&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F04%2Fbad-tactics%2F The other night we admitted a woman with a chronic condition in a very severe exacerbation. She sat huddled up in bed, looking very sick, and pretty much refusing to talk, so most of the history came from an attentive husband. He explained that she’d been diagnosed some seven years ago, “but in 2002 she was healed, so she hasn’t needed any medicines since then.” Umm, right. Turns out she had been in the hospital once in between, but whether because of a misdiagnosis at that time, or because of patient refusal, had not restarted the usual medications. The husband concluded his explanation of the most recent events by saying, “We’re born-again Christians, and we’re just waiting for Jesus to heal her.” I gave them a fairly supportive answer, and... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=948836 Thu, 04 Oct 2007 20:22:47 +0100 948836 http://www.medworm.com/index.php?rid=948837&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F03%2Fvagaries%2F Last night was not so tremendous. Going for 48 hours with about six hours of sleep gets kind of tiring. I did do something pretty dumb by the end of the night. Fortunately not dangerous, but pretty dumb. Partly, also, the night dragged because nobody got seriously sick till the early morning, so there was nothing to do but see some rather boring consults, and answer calls from the floor - never in short supply. The high point of the night was taking a transfer from another tertiary care center at 3am. Since I had actually managed to fall asleep, at first I was rather upset. But the only thing to do really was laugh at the ridiculous situation; which I did; the nurses thought I was crazy. The patient had developed a critical lab value more than 24 hours earlier; the only evidence I had of t... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=948837 Wed, 03 Oct 2007 20:48:32 +0100 948837 http://www.medworm.com/index.php?rid=948838&cid=t_357742_83_f&fid=36527&url=http%3A%2F%2Fcutonthedottedline.wordpress.com%2F2007%2F10%2F02%2Flooks-good%2F The first “day” on night float was great. Time flew by, not dragging as I had expected. Unlike Kitty, the ER timed their “coughs” of patients very well, right in between the crises on the floors. We had one sick patient, and I benefited from watching how the junior (Brad) managed his case, not panicking too soon, calling the attendings and presenting his concerns, and eventually transferring him to the unit. (I will say in regard to one of Panda Bear MD’s recent posts that as for not stopping to drink or visit the restroom for 12 hours straight, he should try covering 50 patients and 20 attendings, and see how much ins-and-outs one has time for. ER does not have a monopoly on busyness. :)  I discovered, again, the point of tiredness at which your feet hurt w... Cut On The Dotted Line blogs http://www.medworm.com/rss/comments.php?id=948838 Tue, 02 Oct 2007 14:39:44 +0100 948838 http://www.medworm.com/index.php?rid=749718&cid=t_357742_93_f&fid=35707&url=http%3A%2F%2Fhemodynamics.blogspot.com%2F2007%2F07%2Fnight-float-md-aware.html I've mostly been in the clinic for the past two weeks, but the otherwise normal schedule of the clinic weeks of internship is broken up for one Friday night by night float. This allows the people on the night float rotation to take a day off. Last night was my night. Today, I'm spaced out and headache-y. Some of the other interns are getting together for dinner and drinks tonight, and I should go, but I feel as if I can't bear to talk to anyone or go anywhere. Instead, I'm sitting in my apartment while Ms. Dr. Hemodynamics is on call, listening to KCRW on the internet, writing this after cooking myself some dinner. I'm not sure when the concept of night float was invented, but it's become a lot more common with work-hour restrictions for residents. In overnight call systems, when residents... hemodynamics blogs http://www.medworm.com/rss/comments.php?id=749718 Sun, 22 Jul 2007 00:51:00 +0100 749718