Woke up tired. Another night that felt like I didnt sleep. Tried to breathe but my nose was clogged. Must be sick. Not bad enough to stay home. Plus, half the patients on the team are sick with probably the same thing. Cant give it back.
Morning report was fine. Had a good teaching point and the residents liked it. Maybe today will finally be a good day on service this week. None so far.
EMR was slow last night. Reset it, hoped it would help. Even slower this morning. Senior resident called about an admission, need to see the splitter with the resident before rounds, dont want to sabotage the progress we made. If the computer stays slow, I dont think I'll finish my pre-rounds. Need a third coffee.
Rounds dont start well. All of the likely discharges say they dont want to go home today. One is angry, his spouse even moreso. I talked with all of them at length last night. Not surprised.
Time to work on the discharges. Headed to the angry ones. Can barely start. We lied. I said 1.5l restriction instead of 2. Almost everyone has a restriction this week. I dont know how to practice because I didnt call the liver doctor. He has a new diagnosis of cirrhosis. No lab abnormalities, has consult as an outpatient. I start to explain the reasons for inpatient consults but I'm just talking over her. And I dont tell them enough of what is happening. They say the resident lied. He mentioned an old hemoglobin, not this AM. She calls him smug. I tell her it's not ok to talk like that to my resident. It has its desired effect. She doesnt pay attention to him anymore. Now it's just me. Patient relations comes in, now she wont talk to us anymore. Probably best.
Specialists are calling. GI cant change the NJ until tomorrow. It's the patients third admission this week because everyone keeps messing up his tubes or his feeds. Hes exasperated, and now I am too. Fine, we will swap it for his stomach and get a friend in IR to advance it. PT changed their note on the angry patient. Meets inpatient rehab now, doesnt have to go home. Looks even more like we lied. The renal transplant is refusing to leave. His diarrhea is almost resolved. Neph is concerned. But his kidneys are fine. Call ID. They are concerned. But his viral studies are negative and he didnt stool for the studies. Call GI. They never do scopes inpatient. Except now they will later this week. Guess we keep him. Hes now stable for the third day.
Should see the hospice patients. First one is lying alone. Need to talk to family. Dehydrating. No IV, refuse lines. Refuse treatment. Refuse hospice. No labs, no treatment, no vitals for over 24 hours. Needs to go home to family, but they're hardly around. Still full code.
Next one. HIV+, colorectal cancer. Dilaudid drip, finally working. Sister is there. Thought he would go home but family cant manage. Yesterday he didnt meet inpatient criteria. I dont think he will last more than two days now. Will keep him here. We discuss life, mortality, guilt, family, pain, health. She cries, then smiles. Easiest patient by far. Never used to be.
Angry one refuses rehab now, wants to go home but needs a Walker. Lost his, insurance wont pay for another. We give him gift cards to get one. They threaten to sue.
Went downstairs to sit for a minute. Its after two, haven't had a chance to get a drink or food since the third coffee. Saw our wellness rep. Had a long talk last week about the system. I have to change it, doctors are dropping like flies. I said I was going to start with the policy that is keeping my splitter stuck on the wards. They listened, they had a meeting and agree the policy needs to be changed. I asked for an early dispensation for her. They said no. It has to go through committees first. I told my colleague this. We both laugh weakly. We talk about him not working the wards anymore. This is just one more example why. I tell him I'll do more than change a policy. I'll burn them all down if that's what it takes. Someone needs to.
They cant do the NJ. The patient is too anxious to do it. A little ativan should help. Nurse paged, new policy states that is procedural sedation, cant do it. Fine. Cancel NJ, give ativan. Set timer for 30 minutes to remind resident to go do it ourselves then. Have to burn that policy too.
Start to sign notes. Have fridays PA notes from clinic. Have yesterdays inpatient notes since the computer was slow. Today's now too. Have to write my own now from all the family meetings and patient complaints. Go to messages. Up to 70. No show reminders from clinic. Inpatient glucose warnings. Behavioral contracts I need to review. Patient complaints about other doctors. Found one buried about a patient out of meds, needs them today. Glad I didnt miss it.
Its 530 now. Still haven't finished the note from the angry patient. If I do it quick, I can be home soon. Will need to eat dinner quick to save enough time to have the birthday party for my daughter. Then off to Boy Scouts. After, maybe a beer. Maybe bed. Maybe tomorrow wont be any worse. Maybe.
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