osodecanela: (cam capture)
As noted earlier, it was a perfectly horrid night. What I didn't note then, was that the 1:15 AM call was just one factor in the night's lousiness.

I was about to head for home, planning a nice salad for dinner for the two of us, when the call came from the ER. There was an elder who had had an apparent TIA (a stroke that passed without permanent damage) who was in the ER and the ER doc was not successful in talking the family into taking the man home for outpatient follow-up. Instead of heading home at 6:45 I was headed home post admission a few minutes after 9pm. Rather than stop at Safeway for overpriced produce, since my roadside green grocer closed at 7:30, I opted for re-heating two slices of the gluten (GF) pizza I brought home Monday, with 2 slices of the regular for my husband. I walked into the sitting room with a tray at a quarter past 10, only to have him take a bite or three, then beg off claiming a sour stomach. He gave the remainder to the dog, who I swear gave him a high five the moment his plate was set down on the floor. (Yes, the wolf-dog adores both pizza and Chinese, the more garlic the better.) It was later in the night when I found out just how sour his stomach was, when at 3 am I was again awakened by noises from the bathroom, as what little he did eat came back up. Sadly, this happened to him a couple of more times before the night was over.

The ER called at 11 stating a women had come to the ER and was too weak to return home, and I would just have to treat her UTI in the hospital. I reminded the ER Doc she had come not from home but a SNF, one that perfectly capable of administering her antibiotics and waiting on her hand and foot until she regained her strength from both PT and her medications. This did not stop the SNF from calling me at 4 am, to ask if they could change her oral solution antibiotic which they did not have on hand to the oral tablet of the same med which they did have on hand. Now, since the next dose of meds were not due until the morning, I have no idea why they had to call at 4, but it did give the RN in that facility the opportunity to talk with me about another patient to get an antibiotic order for a UTI. Why they didn't call in the evening is beyond me, but so be it. Don't all lab results that arrive during the prior evening have to be dealt with at 4 am? (No this was not the same facility that called me at 1:15.)

The bedroom had become too ungodly warm sometime between 3 and 4 am. There is a woodstove in the room and my husband has the unfortunate habit of over filling the blasted thing. (No sweetheart, sauna is not the Finish word for bedroom!) Even though I proceeded to open the window wide, there was not getting back to sleep as I was already drenched in sweat as were the sheets beneath me. Had I been allowed to sleep, that might not have awakened me, but lying on sweaty, damp sheets is quite uncomfortable for me and there was just no going back to sleep with the room that hot. Worse, the room cooled off, but the sheets did not dry out. Cold wet sheets are even more annoying a sensation to me that hot ones. I would have had a few choice words for my husband for once again trying to bake me out of our bedroom, but he was already feeling horrid, and I already felt bad enough that the multiple phone calls had disturbed his sleep as much as mine. I did finally drift back off to sleep, only to have one of my husband's elderly clients call at 10 minutes to 6. I handed him the phone, sans comment.

I did speak with the Director of Nursing at the SNF from the 1 am call, just to vent about the inappropriateness of the late night call. It hit me as I drove in, if she had been riled by the RN from the swing shift that this tube feeding had to be dealt with, then a) why had swing shift not called to deal with it, or b) if it was communicated at change of shift at 11 pm, than why was there no call by 11:30, right after sign out? If it was so crucial that they felt it had to be dealt with right away rather than waiting for the morning (rather questionable judgement in my book), then why did it take over 2 hours after change of shift to do so. The more I thought about it the angrier I got. The DON had already gotten warned by the RN in question, that she would likely get a call.

We'll see how long I last tonight. Of course, it's Thursday which is my late night in the office. At least I'm not the person on call tonight.
osodecanela: (cam capture)
It's been horrifically busy here for the past week and a half. My husband and I were away for a week, and then it was into the fire of work. I'm now in a new call group as of a week ago and last weekend was my first call on what was supposed to be off hours.

It was a clusterf*@k of a weekend, and that's putting it kindly.

Saturday started quietly enough, long enough that my husband and I managed 1/2 an hour of marital time. I had hoped to get to the office and have some time to catch up on paper work. I never actually made it into the office. The phone calls started at 8:30 in the morning and were so fast and furious, I could barely get showered and dressed. It took me over an hour to just get those two things accomplished.

After rounds, discharges and hospital admits, and more phone calls than I could count, I finally headed for home. At 10:15 pm. And finally got to sit down and have some lunch. Although at that point I guess you'd have to call it dinner.

Sunday was not much better than Saturday.

I had planned to call a good friend, who hopefully is reading this, Saturday morning, once I got to my office. Since I never actually made it there, that never happened. Normally I would have called while driving, (yes I do have hands free phone service in the car) but I know how much it distresses him if I do, so I didn't. I never made it to the gym that day, either. Hell, I barely had time to make it to the men's room.

I'm hoping that this was just an unusually bad busy weekend. It it keeps up like this last one, come September I will exit this group. I don't mind making some money, but I don't know that I want to give up this much of my free time this way. It's not worth it.
osodecanela: (Default)
.......this time from one of my own patients. I wish more people (particularly those who're American born) would study this move from the etiquette playbook.

This nice Latino gentleman started the conversation with, "Disculpame Doctor, pero....."
("Pardon me Dr, but....") With those couple of words he acknowledged he was imposing on my personal time, which starts a conversation with a very different dynamic. Just as often i'll hear "lo siento por este molestia..." (Sorry to bother you...). Either statement will get a kindly, "Con que puedo ayudar, amigo?" (How may i help you friend?)

Any conversation that makes it clear, I'm being respectfully asked for my help, as opposed to to being expected to serve, puts me in a very different head space. It sure as hell makes that 1am phone call a lot easier to take.
osodecanela: (Default)
I clearly am capable of being cranky.

I'm generally a patient person, but I have hot buttons that get pushed more than I like. Here are a few phone call starters guarenteed to piss me off:

Any call 30 minutes after their MD's office has closed, asking for a drug refill.
Any call any time, complaining of a symptom that has gone on a week or more, hasn't changed or gotten worse, but somehow cannot wait until their MD's office opens the next morning.
Any call after hours asking for Viagra. (I don't care how hot the date is, being out of any ED med constitutes poor planning, NOT an emergency.
Any call asking me to second guess their own MD (& my call partner) ("He gave me 'X', but I'm not sure I want to take it. What do you think?" Hold on a moment, I don't need to be able to examine you or look at any tests like your provider just did. Just let me consult my crystal ball.
Calls at an un-godly hour of the morning asking for my permission to go to the ER. Do you honestly think the insurer checks to see if I told you to go to the ER?
Any call that begins, " I'm sure I have a bladder/sinus/name-the-bodypart-of-your-choice infection. I took the two days of antibiotics I had 'leftover' from my last infection. I need you to call in more."
osodecanela: (Default)
and to truly screw up requires a computer, which apparently includes the iPhone.

I was on call last night. I really despise call on Thursday nights. It's my late evening in the office and I'm never done before 7 p.m. The phone calls however start at 5 PM sharp, most often people calling to find out why their prescriptions haven't been renewed. Without fail it makes my last two hours seeing patients a royal pain in the keister.

Last night a call came in from a woman concerned about her elderly husband; my receptionist took the call and shortly thereafter handed me the information. For the next three hours I called this woman every 20 to 30 minutes, a busy signal every time I called. Finally the operator tried breaking in on the line, only to confirm that the phone was indeed off the hook.

Finally finished with patients at a 7:45, I sat down to do some paperwork in no rush to head home, as I fully expected to get a call from the ER saying I was needed. At 10:30, I decided I had enough. The evening had been blissfully quiet. I reached for my phone to dial the house, but the call wouldn't go through. The screen kept flashing, "dialing number,....." with nothing happening. Then I noticed up in the corner where the AT&T icon is supposed to be, it wasn't. Only a plaintive little message that read, "searching....."

I had lost the connection to the network. That's why it had been so quiet.

I turned off the phone, then turned it back on again at which time the network came back, along with 21 voicemail messages. The ER had been looking for me for three hours. Three bloody hours. Three whole bloody hours, while I sat at my desk a block and a half away. By the time I got the message, the hospitalist for the night (who just happens to be one of my call partners) had just finished admitting the man.

It never dawned on anyone to try my back office line at that hour, and it never dawned on me to check my phone to see that it was working. Through no fault of my own I now have a major olive branch to tend my colleague.

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