OK. So I am sitting at the resident computer in the CCU. It's been an all right day. Nothing really grand. Two of my admissions from last night went to the angiography suite: one will need surgery and the other will just be started on medication. My other patient will need to resolve his heart failure before he can go to the angiography suite.... if he lasts that long. More on him in a second.
I title this "A Chorus Line" because that's how it feels sometimes on morning rounds. This morning I had those three admissions from yesterday to present. For every question the attending had for me there was a chorus of answers - some restating what I just said, and some giving other information. A few times there was a disagreement with something I had just said which was either later resolved or just thrown out there. Of course, I had 10 minutes to quickly scan the chart while the overnight residents had... um... all night.
There's also an annoying brown-noser we'll call Smithers for fun who kept interjecting an opinion or whatnot between presentations. And, seriously, even though I was presenting directly to the attending, answering all of his questions, etc. total House of God. Outside of rounds, acted as if I didn't even exist even when I directed a question straight to him... oh.. and joy of joys... 2 less days with him since there's a different attending covering this weekend... in case you're keeping count along with me.
Back to my 3rd patient. I've talked about the dangers of drinking alcohol in the past except when you drive (refer to prior posts from ECMC.) Another danger is that you have memory loss (Alcohol affects your mammillary bodies which are important in the brain for logging and keeping memory.) Since you can't remember what actually happened, you confabulate (make up stuff.) There's a great "House" episode where he sends the medical students to go see a patient with a broken ankle. Each comes back with a different story, and he gets a third story when he goes in with the both of them. Kinda like my patient. He can't remember some events of the last month, so he makes things up. Or lies... whatever works.
About three weeks ago this patient had a similar episode but needed to be intubated: breathing tube put in. After a couple of days, he pulled his own breathing tube out... ouch! He was transferred to the floor and decided to leave AMA (Against Medical Advice) despite the fact he still needed to have further work-up done for his heart failure. He stated he had "too many things to do" to be in the hospital. I've explained to him (multiple times - remember, memory issues) that he could die, he's very sick, and he's lucky he didn't need a breathing tube this time. I tried to explain it to the family today, and I seriously think there's something in the water at their apartment complex because I explained things 3 times and nothing was getting through. So, we'll see if this patient doesn't leave again... or elope. Means the same thing in the hospital - just gets up and walks out the door.
Ok... have to leave. It's change of shift, and I am sure the joint will soon be jumpin'. My count down list is changing, and in some ways I think it is even funner than a rating system.... although, I am still suicidal most of the time... especially during rounds.
CCU Countdown:Days left until the end of the rotation: 23Actual number of days I will be working during that time: 20Days left until painful attending returns: 16
Number of days until my next 24 hours off: 5
Number of short call shifts remaining: 3
Number of long call shifts remaining: 2
Number of patients: 3 - 3 in the unit, 0 on the floor
Number of evil nurses in the ICU: 1
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