It’s call day

Today commemorates my first real day of call in about 8 months (6 if you count the ER shifts I did during family medicine that one weekend, but lets get real, they did not count).  The beauty of fourth year is that most rotations you do, you don’t have to do call and if you do, it is generally voluntary.

This call is not voluntary.  Just saying.

I am very out of call practice.  Especially when it is at a strange hospital with a new system.

At least it is home call.  Though, I don’t have a car, so really, that poses a problem.  My favorite roommate has volunteered to drive me/let me borrow her car for the night.  Thank goodness.

I tried to hint that call is not usually required of us politely by saying that I haven’t had to do call on my selectives.  Nope.  And then I pulled the whole, it is a 15 minute walk to the hospital, so don’t expect me right away.  Nope.  No response.  Just a “hope we have a quiet night.”

My call karma (that means my luck with having a “good call” — few consults) is about 50/50.  Sometimes I get slammed, or other times only one or two consults.  Thing is that they generally get anywhere from 3-5 consults per 24 hour period.  5 is a bad day.  I have done 2.  What are the odds?

Bright side… I don’t have a pager here, so he calls me on my cell… And it plays “Don’t Stop Believin’.”  That makes everything a little better.

I am not really complaining (well, I kind of am).  I do think call is a great opportunity to learn.  I would feel better about it if it were easier to get to and from the hospital for me.

Amazingly, the whole routine for Internal Medicine consults has flown back into my head.  Even the starting doses of Plavix and such.  Crazy how something gets drilled in and somehow lives back there somewhere.  So far, we have admitted two heart attacks.  Not surprising, given that most of our currently admitted patients are either in for heart attacks or heart failure.

The interesting part of Medicine call is that you never quite know what you will get.  Some cases are pretty straightforward MIs.  Others are twisted and convoluted House MD like puzzles.  I like those.  Just not at 2 in the morning.  Which seems to be when they like to come in.

Fascinating case that I had this one time (not this call)… 70-odd year old lady with jaundice (yellow) and fatigue progressing over the last 3 months.  History of rheumatoid arthritis and type two diabetes.  Deaf as a post.  LFTs through the roof.  No alcohol use EVER.  No smoking.  Giant list of prescribed medications for blood pressure, diabetes, cholesterol and the arthritis.  No infectious contacts.  No blood transfusions.  No travel… ever.  No family history of liver disease.  Physical exam showed a big liver (not huge, but about 16cm), jaundice, and a grade II/VI systolic ejection murmur.  Blood work showed elevated LFTs.  AST and ALT were elevated, as was bilirubin and ALP.  Thankfully, her INR and blood counts were normal.  She had a cholecystectomy years ago and no abdominal pain.  CT showed nothing.  We sent off serology for hepatitis, testing for a ton of autoimmune causes, levels of copper and iron.  We took her off of her cholesterol medication. We hydrate her.  She does not improve.  Her ANA comes back weakly positive, everything else is negative.  We do another review of her medications and ask about over the counter drugs again.  She had received no new prescriptions for years, but recently had a flare in mechanical back pain that had improved.  She was taking Tylenol regularly at home, but did not require it in hospital.  As it turns out, she was on hydroxychloroquine, which has been shown in a few case studies to cause liver failure very rarely and this likelihood is ever so slightly increased with use of other medications that affect the liver.  With no other options, we consulted the hepatologist and stopped her hydroxychloroquine.  Her LFTs began to improve gradually and she was later discharged to follow up with the hepatologist, as there was some remaining elevation in her LFTs.

Interesting how something that was initially not seen as a threat to her liver, as it is not one of the main side effect can, when combined with something else and possibly some other predisposing factors to lead to liver damage, that, thankfully in her case was partially reversible.

This was one of those “a million possibilities” but it was not the obvious.  So interesting.  Especially when there is a happy ending.

So, call (and beyond) can bring on some very interesting learning opportunities (geeky snort).  Plus, sometimes the things that you see or hear are entertaining… Like the patient today contemplating my age and connections to people around town on the other side of the curtain from me.  Yes, I can hear through the curtain of solitude.  Just like you can.

I still hope my phone doesn’t ring.  At least, if it does, I hope it is Patrick or someone from home on the other end.

And because everyone can’t get enough of Rebecca Black “Friday” parodies… Here is one about the subject at hand…


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