Monday, April 7, 2008

The Little Pink Book

I bought a bunch of these small notebooks when I started this residency. Actually, a total of 6, two in each color. This is the first one, and I have its mate sitting in my white coat out in the car. As a part of our residency program we have to do a "follow up" on a certain number of patients that we see in the emergency department. We want to see "how well we did" in managing their care.

So, I carry my notebook, and every patient I see goes into it. I log down what their presenting complaint was (why they came into the E.D.), what I did (labs, x-rays, etc.), and what their dispo was (dispo = disposition: admitted or discharged.) It's also where I keep track of any procedures I performed: suturing, chest tubes, central lines, intubations, all of my 16 deliveries, etc. We have to have a certain number of procedures to be deemed "certified" and able to perform on our own without supervision.

Usually, I have my little book next to me when I am blogging the past shift's events, but... I left it out in the car, in my white coat, and I am feeling very lazy. So, I thought I would give some general comments about my shift last night:

- again, we were very busy. I think around 3 in the morning, we finally had no patients waiting in triage. Then around 0305 the next patient arrived.

- I am starting to feel like all pediatric thermometers are set at 103.something. I had 2 patients yesterday, and have seen several others, who all had home reported temps > 103 and who had temps of 99, 100, 101 by the time they arrived in triage. Ok, so maybe the Tylenol or Motrin finally kicked in, maybe the fever was at its peak and broke, maybe the trip to the ED in the crisp cool Buffalo air brought the fever down, but still. The kids shouldn't be nice and dry, playful and alert, etc. if they've had that high a fever. Of these two patients, one ended up with a respiratory viral syndrome, and the other I will have to find out about today as I had to sign them out when I left last night.

- I have come to realize that I am no good at math. Everything in pediatrics is mg/kg or ml/kg. Aside fromthe fact we're working in the metric system, and I have to consciously convert Centigrade to Fahrenheit, I just seem to have a mental block when it comes to simple multiplication. Not to mention that I also don't know, off the top of my head, the maximum doses of all of the medications we give (luckily I have my attending and a slew of nurses to remind me). So, it's been quite the challenge when I am called to give a medication order. Which I do, obviously, quite often. Sigh...

- If you're jumped while leaving a bar at 3 in the morning and knocked unconscious, you probably should come into the ED. When your face swells up and looks like Quasimodo's, probably a good time to get that checked out. You shouldn't pop a couple of your buddy's 'pain pills" and then go out to a BBQ with your blurry vision and massive headache. Just not a good idea. Luckily, when his parents finally found out, via an uncle who went to the same BBQ, they made their son come in to be evaluated. Luckily, the CT scan only showed a small fracture in one of the nasal bones, but things could have been much worse. My excitement, of course, was in dealing with something other than vomiting, fever, diarrhea, and, "oh, what's this rash?"

- when you come to the E.D., it is not necessary to bring your "posse" or "entourage" with you. The rooms are small, I am trying to get information, and I don't really need a running commentary or additional information from your supporting cast. There's a rule that only 2 people should accompany any one patient, but somehow others always seem to slip past the front desk, and usually our staff is too busy to notice the comings and goings and exchanges. I don't mind playing to an audience, just not while I am trying to take a history.

- little boys seem to get constipated an awful lot more than girls

- and, finally, there's something about sitting back during those brief moments of "down time" and listening to the "war stories" the nurses exchange with each other. Last night, the comments focused on pregnancy and all of the events that had been witnessed: some funny, some sad, some a testament to my sometimes thoughts that we should adopt a national "contraceptive" vaccine that doesn't allow you to procreate until you've reached a certain age, achieved a passing score on the "baby test" (kinda like your driver'stest, but you're only allowed to fail it once), and passed several rigorous written exams; after which you present with a folder of references and recommendations by others who are nationally certified to procreate. If only...

Ok, off to my last night of being a vampire for a while. We'll see what the evening brings...


pharmolo said...

It's quite interesting to read your off-the-cuff assessment of a night's work, Veronica. Those observations are actually just as important (for yourself and others) as the dry Dx/Tx notes.

lv2trnscrb said...

LOL, I loved your writing and description of your events and observations!
can you use a calculator to convert from Centigrade to Fahrenheit and the other way around etc?

bet you will be glad to perhaps get on a better schedule!


sunnybethe said...

Had to laugh at your comment about the Peds nurses there to back you up on peds med and temp conversions.  Needed to know those things for triage.  And the pregnancy stories~I'm one of those nurses : )  Did it for 28 yrs..I take it your not in it for the long haul.  good luck with your rotation,  Bethe