Day Seven
Friday and Saturday were horrible. Today is better. I feel like a wimp for complaining, though, since my friend
Anna has just completed her first half-marathon! Good for you, AJ!
My bad days came not from admissions, though those certainly happened in quantity, but from ridiculous in-hospital politicking. Let me illustrate:
Earlier this week a patient was admitted with a huge, horrible ulcer on her lower leg. She has terrible peripheral vascular disease and very poor blood flow to the leg. She and her family had been advised several times to have the leg amputated, but she had refused and the family had backed her up. Well, long story short, both the orthopedist and the vascular surgeon whom I asked to see her agreed the leg had to come off and the son agreed to sign the consent (the patient is not competent to sign). This was Friday morning. I call the orthopedist: "Great news, she's agreed to have the leg off, let's do it today."
His office calls back: "He can't do it till Tuesday."
WTF?? I call back and he explains that he doesn't operate on Fridays, the hospital surgical unit is not open on weekends and his regular OR day is Tuesday. He suggests I call the on-call orthopedic surgeon, who is someone different.
The on-call guy never calls back and three pages later, it's now midafternoon and I am getting increasingly frantic. I call my medical director for some help. The first surgeon says he'd be willing to do it Saturday morning, but the hospital policy won't let him. Multiple phone calls later I am talking with the hospital administration and they say they are willing to book the surgery for Saturday am, as an emergency case (which costs extra), but they also warn me that the anesthesiologist still has the prerogative to cancel the surgery if he/she feels it isn't a true emergency. I resist the impulse to reply that if this happens there will be one fewer anesthesiologist in the world.
Against all this set the backdrop of three admissions (none of which I have seen and it's going on three-thirty pm) and the fact that I still have six patients that I haven't rounded on yet, and you can perhaps see why I am at the point of tears as I call my medical director for the fourth or fifth time that day. Yes, the patient got her surgery on Saturday, but there is no earthly reason why I should have had to spend so much of my time and energy on such a ridiculous administrative issue when I had twenty patients to see that day. And the patient had a real problem which had to be treated as soon as possible. ("But she's had the vascular disease for years!" came the chorus from the surgeon and the hospital administrators. "Yes, but she's had this ulcer just six days and it's eaten a twenty-centimeter hole in her leg!" I replied.)
I may tell you Saturday's story some other time, but I'm just not in the mood right now. Sorry. Oh, and I have another admission.
posted by Dr. Alice at #
