Random thoughts about home call.

- It's very frustrating to be paged back into the hospital when you've just pulled into your driveway after a 13 hr day.

- It's even more frustrating to drive in for an emergency that gets delayed by almost 2 hrs.

- It's frustrating to be called in for a case, do all the set-up and then have the case cancelled.

- It's frustrating for the pager to go off right as I've turned off the light and gone to bed.

- It's rewarding to get called in and see over the course of the surgery a very sick baby start to look better.

- It's rewarding to be called in for an emergency on a patient, and have the family remember you from their baby's last surgery (and be glad to see you).

- It's rewarding to be called in and find a true emergency that can be fixed (even if it takes 5 hours or more).

- It's rewarding to hear staff tell you they're glad you're on call.

Good Working Relationships

Right now I am rotating at a hospital where I spent time working in the ICU. More specifically, I was the ICU resident for two consecutive months covering the surgical patients and vented medical patients in a Med/Surg ICU. I took care of the day-to-day stuff with the surgical patients while the surgeons were in the OR, rounded with the surgical team, talked with the families, helped with vent issues in the medical patients and put in/supervised line placements. I responded with the Rapid Response Team and the code team. I got to know the nurses there very well (12 hr days, five days a week, plus at least 6 hr saturdays for two months will do that). I treated them with respect and earned theirs by the way I treated my patients. Recently, I reaped the benefits of that relationship.

I had a case in the OR, the patient was elderly (over 80 yrs) and was having a routine but not minor procedure. There was a larger than expected blood loss (almost 2L) and the patient required large amounts of fluids and blood products. Given the patient's age, type of surgery and the fluid resuscitation required, the surgeon and I decided that the patient would be better served by spending the night in the ICU rather than on the surgical floor. So as the surgeons started closing, I got on the phone to ICU and asked for the charge nurse. I told her we needed a bed and why. She said to give her five minutes, send someone over for the bed, and call report. As I was wheeling the patient over, I saw the charge nurse. I thanked her and told her I wouldn't have asked if the patient didn't really need the bed. Her response was "I know, that's why I didn't argue with you."

And that is why it pays to treat the nurses with respect. If you do that and they respect you, better patient care can be had by all.

Musings on Inappropriate Behavior

I've been thinking a lot about inappropriate behavior at work, especially in light of a few incidents that have recently (in the last few months) cropped up in my presence. One was based on the behavior of nurses and the other the attitude of an Ob/Gyn attending physician.

The first incident basically amounted to a series of comments made by a nurse about a patient and the patients family after the patient was asleep. It was a young man having a circumcision at later than the usual age in this country. She assumed it was the decision for the procedure was made for cosmetic reasons and then went on a rant against the parents for not doing it sooner. She proceeded to talk about how gross it was to see an uncircumcised penis, and how any parent who doesn't circumcise their son should go look at the 80 year olds at the local VA to see how nasty and infected they can get. When reminded that many Europeans don't, she then made a comment about European's lack of bathing. Maybe I'm a little sensitive, because I've had experience with the other side of the coin, if you know what I mean, but I found her whole attitude inappropriate.

But that's nothing compared to this story.

Female, middle aged coming in for a gyenocologic procedure. A resident noticed the "refused" box is checked with regard to blood products. In a conversation with the pt, she reveals that she is studying to become a Jehovah's Witness and as a result does not want blood products. The attending is informed and proceeds to spend the next 10 minutes lecturing the patient, saying things like "we'll only use blood as a last resort" and eventually browbeating her into changing her decision. I was watching this incident and couldn't help but notice the look on the patient's face. I have no doubt she acquiesced out of fear and pressure from her doctor. Now the argument could be made that the patient was not fully rooted in her beliefs and that's why she changed her mind, but watching the behavior of that attending, I would also not be surprised if the patient was implying that the surgery would be cancelled if the patient did not change her mind. Frankly I was appalled at the attending surgeon's behavior. The odds of the patient actually requiring a transfusion were incredibly low and the discussion was almost unnecessary. It was almost as though the attending wanted what they wanted at all costs. As far as I remember from my ethics classes, a patient has a right to refuse any treatment. And, unless I have a question about their competence I have to respect their wished. Now I might have asked the patient if they were sure about their decision, but what galled me about this is the length of time the attending spent pressuring the patient to change her mind.

Any thoughts?

How to ruin the birth of your child

How to nearly get arrested on the day your first child is born, instructions provided by Some Dude.

1. Be rude, nasty, and mean to the labor nurses.
2. When they tell you your wife needs a c-section, insist on being in the room.
3. When anesthesia tells you that you can't because she will be getting a general anesthetic and hospital policy forbids it - declare loudly (with swearing) that you are the Health Care Proxy and that she can't stop you.
4. In response to being told that if you attempt to enter the OR, Security will be called to escort you out, refer to them as Flashlight Cops and say that you can take them.
5. Continue to yell at the staff so loudly that you can be heard three rooms away with all the doors shut.
6. When your family is taking you out of the room and into the hallway continue to swear and yell.
7. When you see security, immediately start yelling about how you can take them, they're thirty years older than you and swear at them, before they even say a word to you.
8. Threaten to punch on of the OB/Gyn residents.
9. Continue to curse and threaten Security as they escort you off hospital property.
10. Be informed that you might be let back tomorrow to visit you wife and new son, but will be arrested if you come back tonight.
11. Loiter just off hospital property and call the local news stations to report about the horrible treatment you recieved.
12. Swear at the local police officers.

Then thank God they decided not to arrest you.

For more about Some Dude or sumdood see here .

The Funniest thing I've read in a while

Be forewarned, you might not totally get the joke if you're not in the medical field or know a little about it but give it a try.

Panda Bear, MD has this offering entitled The Future, or what's left of it.

I laughed my ass off. Then I read it to Peter, who found it kinda funny.