well, here we are in 2012. at least 6 months have passed since my last rant. now, before you go worrying that my ranting days are over, let me assure you that the cavalcade of ED boobery and ass-holery have not slowed, and in all likelihood will never stop. winter brings a special different boobs than summer, but that's another rant. today's rant is on a topic near and dear to my rage bone: nurses.
yes, that's right, i'm back to this topic. let me explain the system for assigning patients to the various teams. actually, let me begin with an explanation of how it is supposed to work. the basic idea is that there are 2 critical care teams, red and blue. each team has 2-3 residents plus an attending. then each team has a complement of nurses--after 4 years i cannot seem to figure out how many nurses staff a particular area in the ED, but there are always some nurses around to do the various nurse tasks, like take breaks, break my balls, go outside to smoke, explain why they won't push some med because they don't want to jeopardize their license.
nurses work really hard--particularly ER nurses. it's a tough job. some people are really cut out for it, and others are not. the vast majority of our nurses are outstanding, but the minority really drags down the majority here.
the basic idea of the teams is that new patients alternate between each team do docs and nurses have time to start a workup on a patient before the next patient arrives. if course there are busy times when people stack up, and that can't be avoided, and if 1 team is getting killed with a few really sick people who are taking lots of time (eg, needing intubation or other lengthy procedures), the the other team will take some extra patients now and the busy team gets some extra patients later. but the basic idea is that each team has the same number of patients.
so imagine my surprise when i return from talking with the parents of a 16 year old who fell 100 feet and shattered his spine and pelvis. in case there was any doubt, telling parents that their 16 year old just sustained a non-survivable traumatic injury is not the most uplifting experience in the world. so i return from the heart-wrenching task to find my team with 7 patients and the blue team with 3; i'll also mention that i've got an intern on my team instead of the usual pgy 2. the guy i left in bed 7 when i started working on the trauma who looked like death and like he needed a tube in his throat 2.5 hours ago now looks like he really needs that tube. my team is setting up for that, which means the other 6 patients are getting no attention. so i casually ask the team leader (a nurse) what's up with the pt distribution. she says "they're intubating in there," referring to the other team.
i look over and all 3 of the blue folks sitting at the desks, working on the computer. and i see that at least one of them is reading "the onion." i briefly wonder how he got past the firewall to read that site, but i'm quickly brought back to reality by the 350 pound person to my left turning blue in fornt of my eyes. i point to this guy and i tell the team leader "so are we!" then i say, "ok, so it goes..."
we intubate the giant and things are calming down (sort of..actually, not at all) when team leader walks over and says to me "you were rude before. it's rude to make pronouncements to people you don't know. i don't really know you that well, but it's rude to walk over to someone and just make pronouncements." this didn't seem like the time to point out that she was doing exactly what she was accusing me of doing, but i did say that i didn't make a pronouncement, i just asked a question; that did not sway her. she explained to me that i didn't understand her job and there was more to it than just the numbers--i agreed to this, but she was not placated. she continued to explain that the other team was intubating and thus couldn't take new patients. i repeated the news that we were preparing to intubate but had just gotten 2 new people. needless to say, this did not go over well. she again pointed out that her job is affected by more than just "numbers."
i apologized again and explained that i was a bit frazzled from the discussion with the parents of the dying 16 year old and that coming back to see such disproportionate numbers caused me further consternation. this was not the right thing to say. "it's not just about numbers." "but we were both intubating, says i.
it really happened like this, with the same phrases being repeated over and over again. she clearly wanted me to know that her job is about "more than numbers." i told her that i understood but that it was hard for all the patients to get good care because we didn't have adequate time to spend with them. i said that while i was happy to care for all the patients it would slow things down in the ED as a whole if the teams weren't evenly filled. i can see that she is just getting madder with every word i say, and although i'm trying to end the conversation i just keep getting myself in deeper. then the charge nurse comes over and ask what the problem is--i mistakenly say i had asked why the teams weren't evenly filled, with the intention of saying that it was explained to me and i was ok with it, but i never got the chance cause the dragon nurse cut in and stated full on yelling at me, repeating the same damn things from the previous 5 minute discussion.
fortunately, another sick person came in, and you guessed it, got assigned to my team. i smiled and said, sure, we'll take him. and i know that the next few shifts i work will be hell because the nurses will gang up on me and give me the worst patients, the most patients, and i am powerless to stop it. it's like some kind of torture/mindfuck. you see something bad happening and you want to make it stop so you say something, but once you've opened your mouth you've instantly made it worse, and despite the fact that you know that this is exactly what will happen you say it anyway...
i never seem to learn my lesson...
Saturday, February 11, 2012
Tuesday, June 14, 2011
no. 51: this is happening.
this story is old, but so good it must be told.
about 6 months ago i was working a night shift and, with a groan, i signed-up for a 20 y/o female patient in room 13. room 13 is the ob/gyn room, so this is not my favorite place to see patients, for two reasons. first, i don't like doing pelvic exams and second, pregnancy seems to reduce some women to quivering masses of ineptitude (please hold off on your cries of "misogyny!"i'm not saying women are stupid, nor am i maligning females with child in general, but, some women get so worried that something bad is going to befall their child that reason disappears like a virgin on prom night).
the patient referred to herein was not one of these women who needs pregnancy to make her stupid--she was almost certainly born a dolt. here are some synonyms for "stupid":
brainless, dazed, deficient, dense, dim, doltish, dopey, dull, dumb, dummy, foolish, futile, gullible, half-baked, half-witted, idiotic, ill-advised, imbecilic, inane, indiscreet, insensate, irrelevant, laughable, loser, ludicrous, meaningless, mindless, moronic, naive, nonsensical, obtuse, out to lunch, pointless, puerile, rash, senseless, shortsighted, simple, simpleminded, slow, sluggish, stolid, stupefied, thick, thick-headed, trivial, unintelligent, unthinking, witless
i thought long and hard about what single adjective best described her lack of intelligence and just couldn't find le mot juste, so i went with all of the synonyms listed for "stupid" on thesaurus.com, mostly as a quantitative indication of her global ignorance, which will become quite evident as the story unfolds.
the chief complaint is listed as "gyn+", which means she's pregnant and has a pregnancy related complaint. i enter the room and see a pale, nervous young woman with brown hair, a dirty white tshirt with a red stain that i took for marinara sauce and gray sweatpants with matching tomato-colored splotches. he boyfriend (partner, husband, well wisher) appeared to have been blessed with the same poor eating skills since he too was spattered in various places with the same putative tomato sauce, including some of both sleeves which lead me t believe that he had been using this portion of his clothing as a napkin. she looked young; she was young.
as i started with the history ("...tell me what brings you in tonight...") i couldn't help feeling bewildered and melancholy. i thought back to what i was doing when i was 20. however irresponsible my behavior had been, the bacchanal never landed me in the ED.
in any case, i was snapped out of my reverie when she said "...i think the baby fell out." i paused and asked her to expound on that idea. she explained that she woke up "take a dump" (these are her actual words). she went to bed feeling well and currently felt the same--no abdominal pain, no vaginal bleeding or discharge, no nausea or vomiting, and no fevers; basically she felt fine and had no complaints.
so...why did she think that baby had "fallen out?"it bears explaining by me at this point that i am recounting this story somewhat out of order from a chronological standpoint for the sake of entertainment. the basic story, as it stands now is this: a 20 y/o woman who is about 12 weeks pregnant comes to the ED at 215am but with no physical complaints or symptoms, but with a fear that her baby has somehow "fallen out"
of her.
back to the story: what was so compelling about her late-night "dump" that lead her to the ED? i was perplexed, since i hadn't yet figured out that she was dumber than a sack of doorknobs. i literally asked her "why do you think the baby fell out?"her answer: "when i stood up, after shitting, i looked in the toilet and what was in there...it looked like a baby..it was the baby...i was scared, so i called 911." i remained confused, thinking that she had left out part of the story. i asked a series of detailed questions: there was no blood in the toilet, no blood on the toilet paper she never had cramps, and the pregnancy had been normal up to this point. i asked her male companion if he had seen it, but alas, she flushed it away before anyone else saw.
it finally dawned on me what was happening: she had defecated, her turd resembled a fetus and she thought, literally, that she had shit out her baby. now you understand where my all this stupidity talk originated.
i spent some time trying to be sure that this was in fact what had happened, and even though in many ways i wish it hadn't been the case, this truly was what she felt had occurred. i briefly explained the anatomy of the female reproductive system and the GI tract, highlighting the fact that they are in fact, not connected. i might as well have been speaking latin for all she appeared to understand. i realized that no amount of explaining would raise her intellect beyond the level of troglodyte. my solution: a quick bedside ultrasound showed a single live intra-uterine pregnancy. a wave of relief washed over their faces, with a similar feeling washing over me, although in my case it was relief that i could quickly (and safely) eject her from the ED (i use "eject"in a humorous way, as in to leave a place quickly (eject mailman, eject!), not as in forcibly removed for dubious behavior).
all in all, it was a fairly benign trip into room 13--no pelvic exam required, no labs needed, no consults or imaging ordered (these are good things since they allow quick patient discharge; if patients need any of these items i don't hesitate, but for a number of reasons, i prefer not to perform tests on/for people who don't need them.
so you decide: which synonym of "stupid" best describes this woman's particular brand of idiocy?
about 6 months ago i was working a night shift and, with a groan, i signed-up for a 20 y/o female patient in room 13. room 13 is the ob/gyn room, so this is not my favorite place to see patients, for two reasons. first, i don't like doing pelvic exams and second, pregnancy seems to reduce some women to quivering masses of ineptitude (please hold off on your cries of "misogyny!"i'm not saying women are stupid, nor am i maligning females with child in general, but, some women get so worried that something bad is going to befall their child that reason disappears like a virgin on prom night).
the patient referred to herein was not one of these women who needs pregnancy to make her stupid--she was almost certainly born a dolt. here are some synonyms for "stupid":
brainless, dazed, deficient, dense, dim, doltish, dopey, dull, dumb, dummy, foolish, futile, gullible, half-baked, half-witted, idiotic, ill-advised, imbecilic, inane, indiscreet, insensate, irrelevant, laughable, loser, ludicrous, meaningless, mindless, moronic, naive, nonsensical, obtuse, out to lunch, pointless, puerile, rash, senseless, shortsighted, simple, simpleminded, slow, sluggish, stolid, stupefied, thick, thick-headed, trivial, unintelligent, unthinking, witless
i thought long and hard about what single adjective best described her lack of intelligence and just couldn't find le mot juste, so i went with all of the synonyms listed for "stupid" on thesaurus.com, mostly as a quantitative indication of her global ignorance, which will become quite evident as the story unfolds.
the chief complaint is listed as "gyn+", which means she's pregnant and has a pregnancy related complaint. i enter the room and see a pale, nervous young woman with brown hair, a dirty white tshirt with a red stain that i took for marinara sauce and gray sweatpants with matching tomato-colored splotches. he boyfriend (partner, husband, well wisher) appeared to have been blessed with the same poor eating skills since he too was spattered in various places with the same putative tomato sauce, including some of both sleeves which lead me t believe that he had been using this portion of his clothing as a napkin. she looked young; she was young.
as i started with the history ("...tell me what brings you in tonight...") i couldn't help feeling bewildered and melancholy. i thought back to what i was doing when i was 20. however irresponsible my behavior had been, the bacchanal never landed me in the ED.
in any case, i was snapped out of my reverie when she said "...i think the baby fell out." i paused and asked her to expound on that idea. she explained that she woke up "take a dump" (these are her actual words). she went to bed feeling well and currently felt the same--no abdominal pain, no vaginal bleeding or discharge, no nausea or vomiting, and no fevers; basically she felt fine and had no complaints.
so...why did she think that baby had "fallen out?"it bears explaining by me at this point that i am recounting this story somewhat out of order from a chronological standpoint for the sake of entertainment. the basic story, as it stands now is this: a 20 y/o woman who is about 12 weeks pregnant comes to the ED at 215am but with no physical complaints or symptoms, but with a fear that her baby has somehow "fallen out"
of her.
back to the story: what was so compelling about her late-night "dump" that lead her to the ED? i was perplexed, since i hadn't yet figured out that she was dumber than a sack of doorknobs. i literally asked her "why do you think the baby fell out?"her answer: "when i stood up, after shitting, i looked in the toilet and what was in there...it looked like a baby..it was the baby...i was scared, so i called 911." i remained confused, thinking that she had left out part of the story. i asked a series of detailed questions: there was no blood in the toilet, no blood on the toilet paper she never had cramps, and the pregnancy had been normal up to this point. i asked her male companion if he had seen it, but alas, she flushed it away before anyone else saw.
it finally dawned on me what was happening: she had defecated, her turd resembled a fetus and she thought, literally, that she had shit out her baby. now you understand where my all this stupidity talk originated.
i spent some time trying to be sure that this was in fact what had happened, and even though in many ways i wish it hadn't been the case, this truly was what she felt had occurred. i briefly explained the anatomy of the female reproductive system and the GI tract, highlighting the fact that they are in fact, not connected. i might as well have been speaking latin for all she appeared to understand. i realized that no amount of explaining would raise her intellect beyond the level of troglodyte. my solution: a quick bedside ultrasound showed a single live intra-uterine pregnancy. a wave of relief washed over their faces, with a similar feeling washing over me, although in my case it was relief that i could quickly (and safely) eject her from the ED (i use "eject"in a humorous way, as in to leave a place quickly (eject mailman, eject!), not as in forcibly removed for dubious behavior).
all in all, it was a fairly benign trip into room 13--no pelvic exam required, no labs needed, no consults or imaging ordered (these are good things since they allow quick patient discharge; if patients need any of these items i don't hesitate, but for a number of reasons, i prefer not to perform tests on/for people who don't need them.
so you decide: which synonym of "stupid" best describes this woman's particular brand of idiocy?
Saturday, February 12, 2011
2011: the year of the...
"...inebriated with the exuberance of his own verbosity."
--benjamin disraeli, speaking of w. e. gladstone
he could of be talking about me.
--benjamin disraeli, speaking of w. e. gladstone
he could of be talking about me.
Friday, September 10, 2010
alec guiness/genuine class
i've recently realized that when my mental well-being is in a favorable location, i have less drive and desire to write. it seems so hackneyed to use writing as a cathartic (that is, as therapy), but i guess i have to admit that for me, ranting in print made me feel better.
in any case, i have not written in quite a while, which is a positive indicator as far as my happiness is concerned.
life is much better as a 3rd year resident--not only because the shifts are shorter (9 or 10hrs rather than 12hrs), but also because i know more, i'm comfortable doing my job, and as a senior resident more people listen to me. it's an odd phenomena--i've spent 2 yrs as an underling and although i felt like i was more respected and "listened to" by the end of 2nd year, i showed up for my first 3rd year shift and suddenly everything i say (ok, most things) are taken as true. 28 days ago i would ask a nurse to give something to a patient and if she didn't like it, i'd get pushback ("did you ask the senior about that?"). attendings have made a similarly rapid and near-complete jump in terms of respecting my opinion (or at least agreeing with me, or letting me implement my plans). these factors make life in the ED somewhat easier since in some ways i am the authority--when i decide what a patient needs i just make it happen, rather than having to talk to someone else about it.
being a 3rd year also brings with it supervisory responsibilities. this is new and exciting; and it is also difficult (but not difficult enough to drive me to write, apparently). more on this in the future.
in 4 days i start in the MICU, so we shall how things play out. my initial worry is that the intern will be a disaster, which will make my life extremely difficulty. i don't know the intern with whom i'll be working so i have no idea if the fear is founded or not. i really enjoy critical care so in many ways i am looking forward to this month, but only time will tell...
in any case, i have not written in quite a while, which is a positive indicator as far as my happiness is concerned.
life is much better as a 3rd year resident--not only because the shifts are shorter (9 or 10hrs rather than 12hrs), but also because i know more, i'm comfortable doing my job, and as a senior resident more people listen to me. it's an odd phenomena--i've spent 2 yrs as an underling and although i felt like i was more respected and "listened to" by the end of 2nd year, i showed up for my first 3rd year shift and suddenly everything i say (ok, most things) are taken as true. 28 days ago i would ask a nurse to give something to a patient and if she didn't like it, i'd get pushback ("did you ask the senior about that?"). attendings have made a similarly rapid and near-complete jump in terms of respecting my opinion (or at least agreeing with me, or letting me implement my plans). these factors make life in the ED somewhat easier since in some ways i am the authority--when i decide what a patient needs i just make it happen, rather than having to talk to someone else about it.
being a 3rd year also brings with it supervisory responsibilities. this is new and exciting; and it is also difficult (but not difficult enough to drive me to write, apparently). more on this in the future.
in 4 days i start in the MICU, so we shall how things play out. my initial worry is that the intern will be a disaster, which will make my life extremely difficulty. i don't know the intern with whom i'll be working so i have no idea if the fear is founded or not. i really enjoy critical care so in many ways i am looking forward to this month, but only time will tell...
Tuesday, May 11, 2010
a wilderness of mirrors
a internal medicine resident friend sent this out:
you know shit went down overnight when you open up internet explorer to this...
you know shit went down overnight when you open up internet explorer to this...
Thursday, January 7, 2010
oh, the places you'll go!
maybe it's the festive holiday air, or the cold is keeping people indoors, but whatever the reason, i've seen a lot of sexually transmitted diseases in the ED over the past few weeks.
the two most memorable were a woman in her 20's who had gonorrhea. i delivered her diagnosis, provided some anticipatory guidance, and then went to get her discharge instructions. she had asked me for a phone so that she could call to get a ride home. when i returned to the room, she was on said phone, yelling at her boyfried: "you're damn right it'f fucking over! you fucking cheated on me and now i have a fucking disease in my vagina. i hate you!" i stood there awkwardly for a few seconds, and i didn't step-in to remind her that the disease was affecting her cervix, not her vagina, and then i muttered "i can see you're busy, i'll be back in a few minutes."
the other notable encounter was a mother-daughter pain who both had their first outbreak of genital herpes. i had seen them both, not knowing they were related (different last names) and remarked to the attending that it was funny that both the patient in room 2 and 3 had herpes. the attending had seen room 2--the mother-- (although she hadn't done a pelvic) and had been told that her daughter was in the next room with similar complaints. we could only wonder at the array of possibilities that could account for such a situation; i felt both amazement and revulsion.
the two most memorable were a woman in her 20's who had gonorrhea. i delivered her diagnosis, provided some anticipatory guidance, and then went to get her discharge instructions. she had asked me for a phone so that she could call to get a ride home. when i returned to the room, she was on said phone, yelling at her boyfried: "you're damn right it'f fucking over! you fucking cheated on me and now i have a fucking disease in my vagina. i hate you!" i stood there awkwardly for a few seconds, and i didn't step-in to remind her that the disease was affecting her cervix, not her vagina, and then i muttered "i can see you're busy, i'll be back in a few minutes."
the other notable encounter was a mother-daughter pain who both had their first outbreak of genital herpes. i had seen them both, not knowing they were related (different last names) and remarked to the attending that it was funny that both the patient in room 2 and 3 had herpes. the attending had seen room 2--the mother-- (although she hadn't done a pelvic) and had been told that her daughter was in the next room with similar complaints. we could only wonder at the array of possibilities that could account for such a situation; i felt both amazement and revulsion.
Monday, November 9, 2009
der hexenhammer
seriously, how do people who write blogs find the time and energy to do it everyday? maybe if one is getting paid, but for real, do these people have jobs? i know there are plenty of jobs that require less work time than mine, but egad, some folks post extensively 4-5 times a week or more! i've been working 12-13 hours a day, 6 days a week since mid-october and i tell you, i don't have the energy to write much. yeah, boo hoo for me.
i'm rotating again on the trauma service, and the patients are just as dysfunctional as they ever have been. in case you never read my prior entries from my time on trauma as an intern (if those actually exist in print or in my mind is something of which i am unsure)the majority of trauma patients fall into 2 catagories: first, the sunstance abusing sociopath who gets beat-up, shot, punched, stabbed, kicked, etc. population number 2 are the demented old folks who fall of ladders, crash their cars, fall down stairs, fall out of wheelchairs, or fall after they have been hit by cars because they were walking in the middle of a dark street at 9pm. people from catagory number 2 are intoxicated about 1/3 of the time, and it's not just alcohol these geezers are imbibing. about 3 weeks ago a delivery van ran over a nice 76 year-old female who, in her own words, ran across the street against a red light because she wanted to be sure to meet her crack dealer before the weekend and it was getting past the time he generally hung out in front of the liquor store. she later admitted to being high on crack when said poor decision was made.
there has also been a steady stream of old men falling off roofs and out of trees. i guess fall (the season) encourages ladder climbing. to be fair, it's not always men who fall; take for example, the following story about an unfortunate 65 year-old female: it seems that she ascended a ladder to clean the gutters and remove other debris from her roof. a portion of the roof is flat so she was actually off the ladder for 10-15 minutes. during this time, her demeted (i use "dementia" here in the actual medical sense)husband thought that she had finished her task and neglected to put the ladder back in the garage, so he did it. now returns the female to find an absent ladder and no means of egress from said lofty locale. fearing a chilly night outdoors, she leans over to see if the ladder has fallen or if anyone is around to retrieve said ladder. i guess she leaned too far because she is now the proud owner of a fractured pelvis and a shattered elbow. ouch.
*****
i will close with an explanation of why i pray for pediatric trauma between the hours of 6-7pm. i don't actaully pray for kids to get hurt, what i wish for is that when traumas come in that time period, i hope they are of the pediatric variety. this is why: i have a pager, it makes noise whenever a trauma arrives. there are different codes for adult and pediatric trauma, and there are also 2 levels of trauma activation depending on the severity (or presumption thereof) of the injury. from 7am until 7pm i have to see every single adult trauma patient who arrives at the hospital. this is not so bad--somedays are slow and i can fit in a nap here and there, and when it's bust it can be fun as trauma patients often need procedure performed upon their injured frames; tubes, lines, stitches, etc. as you might imagine, it can take a good amount of time to deal with a trauma, and they often come in in rapid succession. at 630pm, the night shift comes in and we sign-out the patients on the service--basically, we tell them about all the patients and make them aware of any active issues or things that need to be completed or follow-up overnight. then it's time to go home.
idiots and assholes all over our fair city must know this because there is often a rapid influx of trauma between 6-7pm. the problem here, is that the disrupts the sign-out process, which must happen, so both the day and night teams respond to the trauma and sign-out doesn't happen until after the patient is stabilized. depending on the severity, this can mean extra hours in teh hospital. i do like my doctor-type work, but after 13 hours in the hospital (even if there has been a siesta) i am ready to hit the road.
the caveat is that we don't respond to pediatric trauma. thus, anytime after about6pm when the trauma pager goes off, there are at least 6 people here hoping that it's a kid who has been injured and not an adult. although i can't speak for the others, i always pray for minor injuries.
i'm rotating again on the trauma service, and the patients are just as dysfunctional as they ever have been. in case you never read my prior entries from my time on trauma as an intern (if those actually exist in print or in my mind is something of which i am unsure)the majority of trauma patients fall into 2 catagories: first, the sunstance abusing sociopath who gets beat-up, shot, punched, stabbed, kicked, etc. population number 2 are the demented old folks who fall of ladders, crash their cars, fall down stairs, fall out of wheelchairs, or fall after they have been hit by cars because they were walking in the middle of a dark street at 9pm. people from catagory number 2 are intoxicated about 1/3 of the time, and it's not just alcohol these geezers are imbibing. about 3 weeks ago a delivery van ran over a nice 76 year-old female who, in her own words, ran across the street against a red light because she wanted to be sure to meet her crack dealer before the weekend and it was getting past the time he generally hung out in front of the liquor store. she later admitted to being high on crack when said poor decision was made.
there has also been a steady stream of old men falling off roofs and out of trees. i guess fall (the season) encourages ladder climbing. to be fair, it's not always men who fall; take for example, the following story about an unfortunate 65 year-old female: it seems that she ascended a ladder to clean the gutters and remove other debris from her roof. a portion of the roof is flat so she was actually off the ladder for 10-15 minutes. during this time, her demeted (i use "dementia" here in the actual medical sense)husband thought that she had finished her task and neglected to put the ladder back in the garage, so he did it. now returns the female to find an absent ladder and no means of egress from said lofty locale. fearing a chilly night outdoors, she leans over to see if the ladder has fallen or if anyone is around to retrieve said ladder. i guess she leaned too far because she is now the proud owner of a fractured pelvis and a shattered elbow. ouch.
*****
i will close with an explanation of why i pray for pediatric trauma between the hours of 6-7pm. i don't actaully pray for kids to get hurt, what i wish for is that when traumas come in that time period, i hope they are of the pediatric variety. this is why: i have a pager, it makes noise whenever a trauma arrives. there are different codes for adult and pediatric trauma, and there are also 2 levels of trauma activation depending on the severity (or presumption thereof) of the injury. from 7am until 7pm i have to see every single adult trauma patient who arrives at the hospital. this is not so bad--somedays are slow and i can fit in a nap here and there, and when it's bust it can be fun as trauma patients often need procedure performed upon their injured frames; tubes, lines, stitches, etc. as you might imagine, it can take a good amount of time to deal with a trauma, and they often come in in rapid succession. at 630pm, the night shift comes in and we sign-out the patients on the service--basically, we tell them about all the patients and make them aware of any active issues or things that need to be completed or follow-up overnight. then it's time to go home.
idiots and assholes all over our fair city must know this because there is often a rapid influx of trauma between 6-7pm. the problem here, is that the disrupts the sign-out process, which must happen, so both the day and night teams respond to the trauma and sign-out doesn't happen until after the patient is stabilized. depending on the severity, this can mean extra hours in teh hospital. i do like my doctor-type work, but after 13 hours in the hospital (even if there has been a siesta) i am ready to hit the road.
the caveat is that we don't respond to pediatric trauma. thus, anytime after about6pm when the trauma pager goes off, there are at least 6 people here hoping that it's a kid who has been injured and not an adult. although i can't speak for the others, i always pray for minor injuries.
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