Worst shift EVER

05:00 - Wake up. Dammit...that's 3 hours too early.

06:30 - Wake up. DAMMIT.

07:30 - Hmm alarm is going off, but now too tired from waking up repeatedly. ZZzzzz

08:00 - Alright alright, out of bed

09:00 - Find out my staff for today switched his shift and now I'm working with a ....let's just say he doesn't think highly of family medicine residents.

Patient #1 - Rectal bleed
Greeeeeat. This woman has two ostomies, one functioning and one nonfunctioning. She has no need for her rectum. Except for the occasional stools she produces.....according to her daughter. What? Stool? How is that possible??? Refer to medicine

Patient #2 - Generalized weakness
My staff actually laughed at me for picking this one up. I didn't have a choice, there was no one else on the board. Felt like being sucked into a dark void..........black hole...........Okay....here are some excerpts (with inner thoughts in brackets):

Me: "So what exactly brought you into hospital (oops, open ended question)"
Her: "Well....blah blah blah I read everything there is to know about stroke blah blah I have complex migraines with auras blah blah, just wanted to make sure I was okay"
Me: "But what exactly are your symptoms?"
Her: "Well you know I was filling out this 26 page questionnaire about my migraines. You know, I see the scotomas and the flashing lights but I never really get the headache. It's like my head wants to have a headache, but doesn't"
Me: "Uh-huh (WHAT THE F*CK???)"
Her: "Ok so just tell me what I need to know about TIA's...like how will I know if I had one??"
Me: "You didn't have one. You need to have symptoms to have one. (I have no idea what she's talking about. Is she having an MI? Or did she really have a stroke and all of sudden had a personality change?)"
Her: "Well I was getting the flashing lights and I just sort of started feeling this epigastric discomfort, like when I get my indigestion, but it was different, like kind of a chest compression and then my legs felt weak.......(10 minutes later).... Should I have taken my indigestion pills?"
Me: "Um. um. (think, dammit). Tell me more about this chest discomfort (in less than 25 words)"
Her: "Well it wasn't like a pain or anything, just felt uneasy. I didn't want to take my pills in case it wasn't my usual indigestion, and I just wanted to come here to check it out."
Me: "Do you still have the discomfort? (please say no)"
Her: "Well, no...but since you shone that light in my eyes I'm starting to get the start of a migraine (sorry I was checking for papilledema)"
Me: "What do you mean by leg weakness?"
Her: "Well, you know, my legs. They just feel weak all over. Like they're tired.(BAAARGH)"
Me: "Right. Well, there's nothing wrong with you right now. I can't find any focal neurological deficit on your physical exam. Your blood pressure's pretty high though, why aren't you on BP medications?"
Her: "No, I don't like to take medicine. Just aspirin and my indigestion pills. Maybe I should take 2 aspirins instead of 1? Will that prevent me even more from having a stroke?"
Me: "Well if you want to prevent a stroke you'll have to do some lifestyle modifications, you know...watch your cholesterol, get some exercise..."
Her: "Hell no I'm not going to exercise outside, not with all that nasty air pollution. But I do walk around my house pretty fast. Here, let me get something to write this down. What are the three types of stroke ??"
Me: "(Um....ok this isn't a lecture, I'm here to treat sick people. And besides, I think you already know more medicine than I do). So what exactly is your problem again?"
Her: "So how can you tell on this monitor if I've had a stroke? You know, I have first-degree heart block. They say it's an arrhythmia and that my heart is beating irregularly. Can't that cause a stroke?"
Me: "You didn't have a stroke. Okay, I'm just going to go see a patient who is having chest pain (they were paging me overhead THANK GOD). I'll be back."
Her: "Oh, so you're kicking me out? So in other words, sit down and shut up. But what if I had a T-I-A? How will I know?"
Me: "Um, sure whatever (who knows, maybe she did. At any rate, there is nothing wrong with her now. I need to go kill myself)"

***an hour later ***

Me: "Well all your blood work is normal and your ECG is normal. So I think the only problem here is that you worry too much. But that's a good thing that you're concerned about your health and certainly it was okay for you to come in to get checked out (not okay for me, but I'll live)."
Her: "Don't say I'm too god-damned worried (oops). I'd prefer it if you said I was 'apprehensive'."

Yes ma'am. Killmekillmekillmekillmekillme. I hope she didn't have a stroke. Or MI.

Patient #3 - chest pain
So this guy....lives with his 50-something son. comes in for increasing shortness of breath x 1 month. Today just found it really hard to breathe, and was getting his usual angina. Took 3 nitro pills. Saw his fam doc, who did an ECG and CXR. ST depression in inferolateral leads. So...I'm seeing him...he's got like zero air entry.
Me: "Does you dad have a history of lung problems in the past?"
Son: "No...none whatsover"
Me: (That's funny, his CXR shows extensive scarring)
He's satting 97% on 3L O2...not bad....but he looks a touch jaundiced, and a lot skeletor. How can you let your dad look like skeletor and NOT take him to the doctor? No bloodwork in 5 years in the hospital system.
Hb comes back at 59...hmm...yeah I'd be short of breath too. And ischemic....

Then comes the part when the computer system shuts down for the next 4 hours. We're running around like chickens with their heads cut off.

I call CCU. Can you come and have a look at this guy? He's required like 8 ventolin treatments and his Troponin is 0.24, with ST depression in the inferolateral leads.

Them: "Well, give him 2 units of blood, repeat his ECG, and then call us back"
Me: (WHAT?!?!! He's frickin dying and you want me to call you back???)

4 hours later....where's the blood? Anyone seen the blood? Oh...they haven't sent it up yet?? This guy needs blood STAT and it's been 4 HOURS?!?! The guy's on like ventolin #18 and he's getting worse. And of course we get the first unit in and he goes into failure.

Son: "So, how come his blood count is so low?"
Me: "Well geez take him to the frickin doctor once in a while!!"

Last I saw, he was on BIPAP and headed for the ICU. Had him with me for the whole shift. Poor guy.

Patient #4 - fall
Hmm.............could be easy. Lady with bad hip fell because of bad hip, now bad hip worse. On Xray, she basically had no hip joint. Bone on bone. She had ortho follow up in 2007.

Patient #5 - poison ivy rash with secondary cellulitis
Gross. That's all I can say

Patient #6 - Right hip pain
Piece of cake right? Ohhhhhhh lordy no. She was admitted just 6 days ago with "pain following fall". She demanded that I give her hydromorphone. I said only if you give me the pills in your purse. She said no. I said no.

Patient #7 - ?CVA
Dammit, not ANOTHER one. Although this time, I think he did have one. A small one. With just right facial droop. And he was in Afib. Which the astute medical student pointed out to me when I walked by. Duh, I know...I saw it on the monitor 5 hours ago. He's had afib for 2 years, on diltiazem. And someone decided to put him on coumadin just two weeks ago.

AAAANNNNYWAYS. That was my shift. Yeah I know I only saw 7 patients. That's what happens when the computer goes down and each patient encounter takes 3 times as long.