Sunday, July 06, 2008

Fifth of July

Last night, I had a moderately bad call night. I say moderately, because it could have been worse (that's the mantra for this rotation--it could always be worse.) All day, I was slammed with pages for consults from the ER and the floor, and was trying to wade through them with the help of the team's chief. He's a little ADHD, so when I try to ask him about management it is often a few minutes before he remembers that I asked a question in the first place.

Add to this the craziness that is the Fifth of July in the ER. Everyone gets sick on the Fourth, but no one wants to miss out on the barbecue and fireworks, so they wait to come in on the Fifth. Every service was slammed--medicine had a ton of MI's and rule-out-MI's, one of my fellow psych interns was totally overloaded with people driven crazy by fireworks, booze, and other substances external and internal, and neurology had the joy of receiving consults from a totally worthless PA. Seriously, dude, "sleepy" or "drowsy" does not equal "stroke" or "other neurologic condition." Especially when you ask me to see the patient BEFORE obtaining any labs to rule out metabolic or pharmacologic causes of drowsiness/confusion. Now, if you don't know HOW to work up drowsiness, then fine, make that your consult question, but don't just say "well, it might be neurological" when you don't even know whether the patient is high as a kite, dehydrated from the fine jungle summer weather, has a raging sepsis, or is just drunk. GRR!

Other than that, we were just plain busy. We had patients with dizziness, we had patients with sleepiness, we had seizures and strokes and hallucination/seizure/nightmare/flashbacks-induced-by-loud-fireworks. I'd staggered to the call room praying for some sleep, but received a page probably 30 minutes after falling asleep, so I was extra-groggy for that one. And immediately after writing down that first mid-night consult, I got a page for another. And a page from the floor for a fever, could I write the patient some PR Tylenol instead of PO? I dragged myself downstairs to see the patients, anticipating the long neurological exams I'd have to conduct and dreading them (I just don't enjoy the neuro exam).

This morning, after handing off the call pager, I would start twitching every time it went off, forgetting I wasn't wearing it anymore. I'm going to join my PTSD patients before long. Not to mention I was having word-finding difficulties, left-right confusion, memory loss, and disorientation to place (couldn't find elevator) this morning, putting me right on par with most of my stroke patients.

But the thing that made it all suck, the thing that nearly broke me last night...


No Coke, no Dr. Pepper, only Pepsi. I tried to buy a bottle of water from several machines, but they were all broken. I gave in and tried to buy a can of Pepsi, but the machine was "sold out" and refused to give me back my $0.75, so I ended up drinking Mountain Dew. Which I hate, but it was better than root beer (which I despise). It gave me tachycardia, which made it hard to sleep even when I went to bed. (I could have just gone thirsty, but I was really, really thirsty. Trust me.)

I'm a southern girl. I use the word "Coke" to describe all soft drinks in general, and then name the specific drink I want. Not "soda", not "soft drink", not "cola", but "Coke." It is just not right that every single freaking vending machine in this hospital is Pepsi.

This morning, bleary-eyed, I poked my head in the back door of the cafeteria. The lady said they didn't open till 8, and I nearly cried I was so tired. (Not drinking coffee is not so handy sometimes.) She took pity on me and let me sneak in and pay her cash for a Coke from the fountain.

It was delicious.

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