Last night/this morning, I finished my last general surgery call shift.
I classify it as a win in my books. I survived. And, to quote Patrick’s grandmother, “I didn’t know if I would ever make it.”
This was probably one of my better calls. Aside from me forgetting my phone at home in the morning and trying to stalk down Patrick to get it back (iPhone=brain). It was the best call for sleep for sure. I got a few decent chunks of sleep time. I had a few sick patients, but they were all stable by midnight or so. It was steady all day up to that point, but from then on, just the odd call and assessment.
The nurses at the hospital I work at are really good. The majority have been around for awhile. They have good common sense. They care about the patients. They help me out a ton. In fact, I think I learned as much from the nurses while working the floors as I did the other residents and attendings. Because the nurses are so awesome, there are minimal really silly calls for trivial issues. I am so grateful for them and the work they do.
The thing is, there are some things that you always have to call someone about. Because it is safer to do so than to not do so. Things that are life threatening… You know, chest pain, fevers, new shortness of breath, excessive vomiting, etc.
This is where I got bitter last night. And similar events have happened in the past.
I got called. Out of a dead sleep at 3am to go see a patient with chest pain. Perfectly reasonable. I was already on my way out of bed as I heard the words.
I ordered the routine bloodwork and ECG and headed to the floor.
There, I was greeted by two of the staff who explained to me the patient is on high dose narcotics at home, is angry because we aren’t giving them more and when they were told this promptly started to complain of chest pain.
But still, you just never know. Bad stuff happens.
So, I go in to see the person. They look comfy. They don’t look sick. Their vital signs were better than mine.
They give a story of having chest pain for the entire day and night. It got worse a few hours ago. The nurses are withholding pain medications. Now, the person can’t move that side because the pain is so bad (as they move said side to demonstrate). And the story kept changing. And was inconsistent with most pain, except maybe post-op pain, but even that was a bit dicey.
Their ECG was normal. Their bloodwork was normal.
So, I had the whole, it doesn’t look like anything life threatening talk with them. And they asked for more pain medication in addition to the additional stuff that I just gave them. I questioned this, as they had just said the pain was subsiding. To this they said they could feel that it would come back. I said to let the staff know if it did.
I am all about helping people. And good pain control. And giving people the benefit of the doubt. But nothing makes me want to punch a person in the face more than when they are clearly trying to manipulate me and they do it in the middle of the night with a complaint that could be really serious.
I had someone else a few weeks ago who was being super rude to all of the nurses and roommates and started complaining about coughing up blood in the middle of the night. Same sort of deal. They did cough up a bit of blood. The also had a nosebleed earlier in the day from pulling out their NG tube earlier in the day. But, they did that earlier, but chose to point it out in the middle of the night when they were starting to be ignored. I ended up getting stuck there for an hour debating the reasons why medications are sometimes given late and why we won’t give him more benzos and the like. Really nothing to do about the mysterious blood.
I had someone else who every time we have tried to send them home, they present with a new problem that precludes discharge. Pain, a new rash, dizzy spells. They are genuinely sick. But they also lean towards the dramatic. It gets frustrating. I just want to see them get well and go home. Partly because it gets tiring for us getting called to assess and making arrangements just to have them changed. But also because sometimes the best thing for people is to not be in the hospital.
I probably sound heartless. I love people. I love my job. I enjoy taking care of people. But, nothing is more annoying than people who take advantage of the system or who manipulate you. Especially in the middle of the night. When other people are actually sick (or you are trying to sleep).
Some people have genuine issues both with their mental or physical health and can come off as manipulative. I take them seriously. I investigate appropriately. Except sometimes it is hard because they don’t give you much to go on. Or it is clear that things aren’t as they say. Then, I kind of secretly want to punch them in the face. Especially when I am in the midst of getting pages about people with more pressing issues. Or when nursing staff are being taken away from sicker people. Or when we are all being abused.
There is an element of common sense here. Some people don’t seem to have it. And I suck at being a jerk. So, often I still get caught up with these people until I get so annoyed or confirmed that they are being manipulative or drug seeking to talk them down. I am getting better at judging this and approaching it. I just don’t like to be mean. So, I try to educate. It takes longer. It works most of the time. It doesn’t mean I still don’t want to kick some people in the teeth.
I guess such is life. There are always those people you want to kick in the teeth. And it is most often at a time when you don’t have the time to deal with it. It amazes me how self centered we as people (on both sides) can be… Me for wanting sleep or to deal with people with problems I need to fix and them for, well seeking attention for problems that, at least from the outside, can seem trivial (though for the person they can be significant).
But, yay! I survived Gen Surg call. And I didn’t kill anyone… Literally or figuratively.