Call #5
As I’m waiting for the elevator to go into the hospital, a mother and her little girl pass by. The girl says to her mom, “Look, Mommy! A doctor!”
She meant me. How cute. Things go downhill after that.
I discover that on my day off, Mrs. Jefferson developed a fever and her white blood cells are elevated. She was supposed to finally go home tomorrow, but now it looks like that plan is at least temporarily on hold.
Just my luck. I mean, just her luck.
There’s already an admission waiting for us from the night service. I meet Alyssa in the resident lounge to get sign-out from the overnight resident who did the admission. She looks decidedly pissed off when she sees me. But what else is new?
“How come you didn’t do the discharge paperwork on Mrs. Rogers?” she demands to know. “She went home yesterday and I had to write her discharge while covering both your patients and Connie’s.”
“Mrs. Rogers was discharged?” I’m shocked. As of two days ago, she looked like she was practically dead. Well, she smelled dead, at least. Alyssa just shakes her head at me. “In the future, if you know a patient is going home on your day off, you need to do the discharge
summary in advance.”
I also need to develop psychic abilities, apparently.
“Sorry.” I can’t help but ask, “Did you ever figure out why she smelled so bad?”
Alyssa looks horrified by my question. “Excuse me?”
“Well, she had that smell,” I say, “and it was really bad, like the whole hallway smelled horrible, and nobody knew why…” I stop short, aware that Alyssa is glaring at me. “Never mind,” I mumble.
I guess I’ll never find out what that smell was. Damn.
“Also, Mr. Dugan had a headache this morning,” she says. “I wrote an order for some ibuprofen for him.”
“Actually,” I say, “that’s probably not the medication I’d pick, considering he’s got renal insufficiency.”
Alyssa gets quiet for a minute. Finally, she says, “Yes, that’s true.
Switch it to Tylenol.”
Score! Alyssa actually admitted I was right about something. This may never happen again. I need to savor it. Ahhh.
I hear a loud whirring noise coming from outside and a large scooter navigates into the lounge. Sitting atop the scooter is a resident named Jim, who was the senior admitting overflow patients last night. Why he’s sitting on a scooter is beyond me. I saw him no less than a week ago darting around the hospital on his own two feet. This is just bizarre.
“Jesus Christ,” I say. “What happened to you?”
Jim’s face lights up, clearly loving the attention of zipping around in a scooter. “You won’t believe this,” he begins. “So you know that big dumpster behind the hospital…”
Alyssa clears her throat loudly. “I’m sorry but we don’t have time to socialize right now. Could you just tell us about the patient, please?”
“Spoilsport,” Jim grumbles as he fumbles through the papers in the basket on his scooter. Seriously, this is so weird. And what did Jim do in that dumpster that landed him in a scooter? “Aha, here we go. The patient is Richard Thurman, 38 years old. At about 4 a.m., he was FOOBA.”
I frown. “FOOBA?”
Jim winks at me. “Found On Ortho, Barely Alive. The guy had a severe traumatic brain injury from a motorcycle crash, but orthopedic surgery was keeping him to nail his femur fracture. He was looking pretty puny last night, going in and out of a-fib, his blood pressure all over the place, his blood sugars completely uncontrolled. He’s still pretty sick, so you better keep a close eye on him.”
Alyssa does not look pleased. “Maybe he’d be better off in the ICU if he’s that sick.”
“Nah,” Jim says. “Frankly, his worst problem is that he’s FOS.” I raise my eyebrows. “FOS?”
“Full of shit.” Jim snickers and my heart skips a beat. Please don’t let me have to do a stool disimpaction. “Don’t worry, Jane. I threw some Mag Citrate at him and I think most of it came out.”
Thank God.
After Jim zips away on his scooter, Alyssa and I go to pay Mr. Thurman a visit. When we see him, it’s pretty clear that his femur fracture is the least of his problems. Whatever happened to his brain was
pretty bad. He’s two months out from the injury, and essentially in a minimally conscious state. His eyes look in two different directions and his only actions are to try to pull at his tubes, which is why his arms are in restraints. He has a long scar along the left side of his scalp and underneath a large chunk of his skull seems to be missing.
Per his chart, Mr. Thurman was in a motorcycle accident and he wasn’t wearing a helmet. I’m not a risk taker and I’ve always thought motorcycles were scary dangerous. I mean, cars have a ton of metal protecting you, and then airbags on top of that, but when it’s a motorcycle, there’s nothing but air between you and the other cars (or the ground or a tree). So it seems like the least you could do is protect your skull with a helmet. But not everyone feels that way, apparently.
I’ve heard that motorcycle riders have lobbied against helmet laws, saying it’s a violation of their rights. What I don’t understand is why wouldn’t you want to wear a helmet if you were on a motorcycle? What excuse could you possibly have? It’s uncomfortable? It makes you look uncool?
Believe me, if pre-injury Mr. Thurman could see the way he looks right now, he would not be pleased.
Alyssa gives me the all-important job of tracking down exactly how much poop has come out of Mr. Thurman this morning. But before she goes, she has one final set of words of wisdom for me.
“By the way,” she says. “Mrs. Jefferson had an elevated white blood count two days ago. You missed it.”
I stare at her. “What? I didn’t miss anything.”
Alyssa nods. “You did. The labs you wrote down in your note for that day were from the day before.”
I pause for a second, contemplating how this mistake could have happened. The answer is: easily. I saw a set of labs and wrote them down, not bothering to double check the date on them. I can just see how I might have done it.
Of course, half of Alyssa’s job is to look at labs. Sometimes I catch her in the computer lab, just sitting there reviewing labs for large chunks of time. So the missed lab was as much her fault as mine.
Maybe even more her fault than mine.
But I don’t say that. Instead, I say, “I’ll culture her and start antibiotics.”
I’ve noticed the nurses don’t particularly like me. It’s not that they dislike me, but they definitely don’t like me even though I’m fairly polite and respectful to them. Here’s the thing: if you were doing a job for over twenty years and then some 25 year old came in and you were expected to take orders from her, how much would you like that person? Not a whole lot, that’s how much.
Unless, of course, that person was incredibly handsome, like a certain surgery resident I could name.
A nurse named Patti flags me down on the telemetry floor in the afternoon and has a pile of annoying questions for me.
“Doctor,” she says. “I need to talk to you about the new patient Mrs.
Levy.”
“Okay,” I say, bracing myself.
“We need to open up a bed on this floor,” she says. “Mrs. Levy already had two sets of cardiac enzymes that were negative, so can we move her to the regular floor?”
“What about the third set I ordered?” I ask. “We didn’t draw it,” she admits.
I raise my eyebrows.
“It wouldn’t be back yet anyway!” Patti says.
“Well, it definitely won’t be back if you never draw it.”
Patti just glares at me. But seriously, she knows I’m right. The rule is three sets of negative cardiac enzymes before they can leave telemetry.
“Also,” she says, “Mr. Gregory in room 2O4 wants to eat.”
That’s a patient I’m cross-covering so I check the sign-out. He’s supposed to have surgery today, which means he can’t eat.
“Sorry,” I say. “He’s NPO for surgery.” “But he’s really hungry,” Patti whines.
I want to ask her if this is a serious question. I’m sure Ryan would be screaming at her by now. Actually, he wouldn’t, because she wouldn’t dare ask him such a dumb question.
I glance down again at the sign-out for Mr. Gregory to see if they’ve added any helpful hints. In addition to the note about the surgery, the resident had typed: “If patient is agitated, give him a dose of fativan.”
Fativan? As far as I know, there is no such medication. There is, however, a sedative called Ativan. Presumably, the intern meant Ativan, which calms you down. Unless he really meant fativan, which… I don’t know, makes you fat? Or less fat?
“You can give him some Ativan,” I say generously. Patti nods, somewhat placated.
I get a page and rush to respond. It turns out Mrs. Jefferson is now experiencing chest pain. It seems she’s never leaving us. Welcome to your new home forever: County Hospital.
Hours awake: 5
Chance of Mrs. Jefferson going home this week: 15% and dropping
