The morning after the nights before.

Holy crapping monkeys, as my coworker Kathy would say, it's been a week. Working four nights in a row leaves you in much better shape than, say, working two nights, being off for a day, and then working two more....but HCM, what a mess I was this morning.

I'm finding that I really like becoming a generalist. Though Sunnydale is primarily a neuroscience facility, we also see what are called "complex" patients. Those are folks with massive, complex medical histories that wouldn't normally be able to get the sort of surgical or medical care that we provide in the itty-bitty towns where they live. As a result, this week I've taken care of a patient with a neobladder (so freaking cool--hey! Let's make a new bladder out of this piece of intestine! How about it?), one poor dude with some whacked-out chest surgery, a woman with an incredibly complex breast reconstruction that involves moving some bits here and other bits there, and a couple of people with your average, every day, run-of the mill stuff like aneurysms and infiltrating sinusitus, who also have X, Y, Z, and Z to the X wrong with 'em.

My eyes still glaze over when I see an EKG rhythm other than normal sinus, but I *really* dig seeing fresh post-op patients and their various problems.

Sometimes those problems require more of a light touch than at other times.

I was settling in a fresh post-op last night whose angiogram had run later than we'd expected. They'd managed to coil the dude's aneurysm, but one of the coils had gotten loose and had had to be retrieved, which took a little longer than usual. He was fine--grumpy about having to lie down flat for six hours, but otherwise okay--so I was able to take some time between hourly neuro exams and chat with him.

He started talking politics. Now, regular readers of this blog know that I don't talk politics or religion with my patients. If they ask, I'm a Democrat, a conservative Republican, a Christian, or a Blorgian yak herder--whatever gets me out of the room and doesn't raise either of our blood pressures. So this time, as in the past, I kept my eyes down, my hands busy, and my mouth shut while Aneurysm Dood bloviated.

Health care, as it turns out, is not a human right. Nope, no sirree. Health care of any sort is one of those things that the deserving work for, by God, and no socializt preznit is going to tell *him* any different. Why, if you need something, you should just go to the emergency room, right? (I didn't say a word. I swear.) Nobody should get what they haven't earned; if they take something for free, like health care, they're nothing but a drain on the system.

(Parenthetical note: why did this guy assume that I would agree with him that health care isn't something that everybody ought to get? I mean, did he not realize that I see the effects of untreated hypertension and diabetes every day? I know, I know; rhetorical question.)

In fact, that's what *he* did. He had a terrible headache, and some vision changes, and drove himself to the hospital--no socializt ambulance for him!--where it was discovered that he had an aneurysm that was just about to go nucular, if you'll excuse the term.

Whereupon he was airlifted, on a two-hour whirlybird flight, to our fine facility. We called in the neuroradiology fellow, a couple of CNAs, the radiology techs, a nurse or three, and promptly coiled his aneurysm. We then moved him to the CCU, where I was busy dealing with his incredibly labile blood pressure.

Where, glory be to the Great Watchmaker and technology, he was well enough to bitch about socialized medicine and the takeover of our good, clean American society by left-wing radicals interested in running our lives to the nth degree. He'll spend the morning in the CCU tomorrow, then be ambulanced home to Teensyville, where he'll return to normal life, except for a checkup in six months.

I was glad we were able to help him out, even if his particular views were odious to me personally. I was even more glad when I saw his face sheet, with the code next to the financial number that means his care was paid for by the hospital as a charity case. Everything, from the airlift to his breakfast in the morning, will be financed by Sunnydale; it's part of our commitment to provide free care to one in five patients.

Those damn socializts. By which I mean us.