Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Wednesday, December 21, 2005

    This is one of the worst call nights of recent memory; it's 3 a.m. and I just got home. I have no idea why I am compelled to post about this right now, but I might as well strike while the iron is hot. Be prepared for misspellings, cliches and general poor writing as there is no way I am going to proofread this when I am done.

    I got admission Number One at 4:30 this afternoon (make that yesterday afternoon). He was no problem; an elderly gentleman who had fallen and sustained a minor fracture, also likely had a pneumonia. All would have been fine if I hadn't accidentally locked my keys in the car like a frigging idiot upon arrival at the hospital. I went ahead and saw the patient while frantically calling around for help. I struck out with Security and teh Parking Administration had gone home. As a last ditch, I called V. God bless you, V.! She had just arrived home but came back to get me so I could retrieve my spare car key from my house.

    Back at the hospital, I finished up Admission #1, walked to the car, put my key in the lock and opened the door triumphantly --

    and got paged for Admission Number Two. Elderly woman with sepsis from a urinary tract infection. Low blood pressure. Diabetes.

    Okay, she's done. I stopped off at the grocery store to pick up something to eat for dinner, got home took out the trash. It's now, oh, 10:30 p.m. I was paged with Admission # 3 as I walked into the house. I ate dinner and as I did I was paged with Admit Number 4.

    Somebody up there hates me.

    Back at the hospital, it's now midnight. I deal with #3, a rule-out MI, and go on to #4, a patient with pulmonary edema (think a very fast, very severe case of congestive heart failure). As I got Patient number 4 finished up, the ER doc came up to me and informed me that #2 was ruling in for a heart attack, probably brought on by her extremely low blood pressure and sepsis. As I coped with that, another ER doc informed me that #3 also looked to be having a heart attack.

    "What the hell!" I shrieked. "Is it something in the water?! Everybody's infarcting tonight!"

    Did I mention there are no unit beds? NONE. The ER is "closed" - meaning that ambulances are not supposed to be taking patients to that particular hospital, since there are no intensive care beds available. Patients 2, 3 and 4 are still in the ER with no prospect of getting rooms tonight.

    I have a full day in the office tomorrow. I'm going to bed. God knows whether I'll even be coherent when the alarm goes off in 3.5 hours.

    Coda. The pager went at 6:15. Mambo Number 5: congestive heart failure. For God's sake, people, lay off the salt!

    (I caved and signed that one out to the day doctor, who was very nice about it.)



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