Always. It's one of those immutable laws of the medical Universe: if you have a person who's had, say, a minor bladder-scoping procedure, that person will choose a holiday (preferably one with a three-day weekend involved) to have something completely nuts happen that lands him or her on six drips and a vent. We once had a patient who came in to have a couple of teeth removed prior to some other surgical procedure who coded on the table: it was the day before Thanksgiving.
I mean, *really*? (Side-eye at Murphy and his laws.)
One good thing about having residencies that last at least five years, which is all of the ones that I work with regularly, is that you don't get too many bright-eyed, idealistic young medicos on July first. Most of the docs who rotate in and out of the units have been there before and have just been out doing research, or something. They're the same exhausted, cynical people we've worked with forever.
We do have one rather dashing new fellow ("fellow" in the academic sense, though he's also got XY chromosomes) with a Spanish accent and Italian shoes. He glided in yesterday, did a very thorough exam on one of my patients, then discharged her home without any fuss or muss. It's nice to see efficiency. I doubt the Italian shoes and silk tie will last through August. I hope the lack of drama does.
July is also the beginning of the yearly fiscal crunch for State-funded agencies here Deep In The Heart. Some of my colleagues have simply gone missing, laid off in the face of gazillions of dollars of shortfalls. Others are walking around looking tense about the possibility of losing their jobs. It's all Manglement positions that are being cut, no front-line staff, but that doesn't make it any easier. Nobody's hiring, either. What that means at the end of the day is that if you're working in research, you now have thirty more cats/pigs/rats to deal with in addition to the ones you were already taking care of. If you're a mid-level Mangler, you've got six more pages of audits and quality-improvement surveys to do every week, and no help.
Maybe they could get the residents to help with the audits. It'd at least give 'em a chance to sit down once in a while.
Jo - just a quick personal note to ya about rare tumors. I've just joined you in the "I'm the 4th patient my doctor has ever diagnosed" crowd.
ReplyDeleteI have a rare (or at least very unsusual) sarcoma on my forearm. They're going to use my tissue slides for teaching. They estimate 10,000 physicians will eventually look at me through a microscope.
The dermatologist removed the tumor mass, but you have to go way far out to get clean margins. The new vocabulary word in my life is dermatofibrosarcoma protuberans.
Wish me luck!
Dave Doyle
Pinedale, Wyoming
My dad was ob/gyn, and until he got a partner, was gone every holiday. The patient crumps during the holiday, the kid is always born during the 4th quarter of the biggest game of the year, etc.
ReplyDeleteGlad your new guy seems to be a champ, and hope he doesn't become a chump.
I thought that the brand new Resident who as assigned to my patient yesterday looked as though she was ready to cry at the drop of a hat. Her head was about to explode when I asked for an order for KPhos.
ReplyDelete"So what would you like to give.... cause this is the first order I have ever written...."
Oh love July in the ICU....
>... here Deep In The Heart. ..., laid off in the face of gazillions of dollars of shortfalls.
ReplyDeleteTake that statement back!
I thought Gov. Goodhair said he had a budget surplus, during his last campaign?
In the UK it used to be the 1st August and 1st February (slightly less bad) and following few days that were the dates to avoid being ill. Then they had a wonderful idea - make them rotate every 2 months. Now noone knows how to avoid the newbies.
ReplyDelete