Frustrating and Long Call
Yesterday and last night and this morning seemed to drag on forever. Partially because they did.
The whole structure of the admitting team and call at the hospital here is pretty taxing and inhumane. Plus the patients and families aren't usually even happy so you feel like it's all sort of for not as much as it could be for. (Keep in mind I've now been up for 34 hours straight as you read this and let that help explain the incomprehension and frusteration.)
So we don't start admitting as the call team until 6pm and then we admit all night until 6am the following morning. I got five patients all spaced out enough to keep me up all night. Plus my old patients. One of whom is having horrible headaches as I'm trying to be patient as the med student takes the eternily detailed history from the 17 year old girl with the nonspecific abdominal pain. Another who is yelling "MAMA" at the top of his crying voice over and over because his mom has gone home to take a shower. The nurses finally close the door to his room.
But the nurses themselves get loud also. They start talking again about how many hours they work at a time (12) and how it's so awful to work three days in a row. "I worked a five once three years ago," one of them brags, "Never again, I was going crazy by the end of it." I try to tune them out. I have worked now for four straight weeks with one day off in the middle. And those days are nearly all longer than 12 hours. Some, like last night, are 32 hours.
Plus I still have a lot of unaddressed anger toward nurses because of what Michael did. I can just picture that little bitch that he slept in with those nurses. She was a night nurse. Chatting and cackling and gossiping and complaining and flirting with my boyfriend...or calling him...or sleeping with him...or going out with him while I was home alone in the apartment we shared...I'm beginning to wonder if I'll ever be able to get over it. There is one who even looks a little like her and I have to try to over compensate so I don't glare at her too much and treat her poorly.
I was so tired after being up all night and I was just pushing through to get out on time at noon. And for once I had all my stuff tied up enough to check out to the cross cover person. But then at 12:20, as I'm already annoyed that people are wasting my time and not letting me get home, I get a page that one of the specialist attendings for my 9 year old girl with a resolving sandpaper rash with finger desquamation (all the skin pealing off the tips of her finger). She wants to have the whole team gather to go over a physical exam on my patient because we'd missed some key things for the diagnosis of this disease in which she is the national expert. "Are you fucking kidding me?!?" I sat to myself. Exhaustion and frusteration diminish me to profanity. I called my senior who says, yes, I do have to go. Even though we're post call. Even though I was ready to leave 40 minute ago. Even though I have been up all night. Even though this attending might keep up for an extra hour.
Yes, we missed things on the physical exam, the little girl came in at 4 am and she was completely exhausted. She could barely keep her eyes open, let alone get up and talk about how she has been walking as the attending was now demonstrating. Yes, we missed it, and in the same situation I would choose to miss it again. She was not in acute danger. The attending had already micromanaged to the point where we weren't going to get to make any read decisions about her diagnosis or treatment anyway. We were really just a glorified babysitting service for her.
When she finally finishes, the nurse of my screaming patient calls and says mom has a bunch of questions and she's going to "escalate" if I don't come talk to her. Are you kidding? Who comes to talk to me when I decomensate as I am about to. I already almost broke into tears inte the middle of the pod with the med students. So, on my way out the door I talk to her, and she's totally calm and reasonable...she just feels helpless and wants to have some control and input into the care of her 3.5 year old boy with only 10 cm of small bowel. That's totally understandable. And why do the systems issues at this hospital make parents feel like they have to fight for what they want. What has created this somewhat advisarial atmosphere? We all want the same thing, don't we? Good Gosh. Systems of management that make you feel that way are crap. It is just so frusterating.
And what does she say when I get to her room? "I thought you'd be gone by now. You look tired." I am tired.
Then one of the attendings sees me finally leaving the hospital at 1:30, "Getting out post call at 1:30--no good." I'm not sure if it's a reprimand or just something to say. Like it's somehow my fault that I'm leaving at 1:30. It's like the collective awareness of the hospital objective and goals and call time regulations is missing. The same attending who showed us all the physical exam at 12:40, then walked out of the room and tried to send two of the med students down to the lab to see a smear of spun down urine and report back to her. I just bowed my head lower over the orders she was having me right to hide the disgust and disbelief on my face. Was this really happening? Does the systems have that little awareness of the pieces that compose it? Finally, our senior stood up for them and said they were post call and would not be able to go right then. "Oh. Well, report back Monday, then." She sounded slightly dissapointed.
This is a time of the new work-hour rules in medical training programs and all the attendings did not have them so many of them have this sort of unspoken aura of, "Back when I trained we worked harder than you all; and I think it's ridiculous that you can't stay all day post call like we used to have to." Whatever.
Plus I feel overall completely underappreciated and superfluous to the whole system. I cannot make any changes to plans without running it by at least three people. It stifles my ability to formulate management plans on my own. When it feels like I am nothing more than a convenient order-writer for what other people have been able to think about and discuss and learn. It feels like it could run very well, if not even better, without us. It's not a good feeling.
Finally, I got out of there, but had to pick up my first paycheck (yep paid only once per month) and they still haven't figured out how to do the direct deposit. So I have to stop at the other hosptial on my way home. I am so tired that everytime there is a red light I close my eyes and nearly fall asleep. My reflexes are noticably slowed and I am trying to be extra deliberate so I don't get in a car wreck.
I figured out how much I make at day, less than $100, and if hourly then it is just about minimum wage. We make less than any other program in the country that I know of. And it costs more than nearly anywhere else to live here. Something is wrong with this picture.
The whole structure of the admitting team and call at the hospital here is pretty taxing and inhumane. Plus the patients and families aren't usually even happy so you feel like it's all sort of for not as much as it could be for. (Keep in mind I've now been up for 34 hours straight as you read this and let that help explain the incomprehension and frusteration.)
So we don't start admitting as the call team until 6pm and then we admit all night until 6am the following morning. I got five patients all spaced out enough to keep me up all night. Plus my old patients. One of whom is having horrible headaches as I'm trying to be patient as the med student takes the eternily detailed history from the 17 year old girl with the nonspecific abdominal pain. Another who is yelling "MAMA" at the top of his crying voice over and over because his mom has gone home to take a shower. The nurses finally close the door to his room.
But the nurses themselves get loud also. They start talking again about how many hours they work at a time (12) and how it's so awful to work three days in a row. "I worked a five once three years ago," one of them brags, "Never again, I was going crazy by the end of it." I try to tune them out. I have worked now for four straight weeks with one day off in the middle. And those days are nearly all longer than 12 hours. Some, like last night, are 32 hours.
Plus I still have a lot of unaddressed anger toward nurses because of what Michael did. I can just picture that little bitch that he slept in with those nurses. She was a night nurse. Chatting and cackling and gossiping and complaining and flirting with my boyfriend...or calling him...or sleeping with him...or going out with him while I was home alone in the apartment we shared...I'm beginning to wonder if I'll ever be able to get over it. There is one who even looks a little like her and I have to try to over compensate so I don't glare at her too much and treat her poorly.
I was so tired after being up all night and I was just pushing through to get out on time at noon. And for once I had all my stuff tied up enough to check out to the cross cover person. But then at 12:20, as I'm already annoyed that people are wasting my time and not letting me get home, I get a page that one of the specialist attendings for my 9 year old girl with a resolving sandpaper rash with finger desquamation (all the skin pealing off the tips of her finger). She wants to have the whole team gather to go over a physical exam on my patient because we'd missed some key things for the diagnosis of this disease in which she is the national expert. "Are you fucking kidding me?!?" I sat to myself. Exhaustion and frusteration diminish me to profanity. I called my senior who says, yes, I do have to go. Even though we're post call. Even though I was ready to leave 40 minute ago. Even though I have been up all night. Even though this attending might keep up for an extra hour.
Yes, we missed things on the physical exam, the little girl came in at 4 am and she was completely exhausted. She could barely keep her eyes open, let alone get up and talk about how she has been walking as the attending was now demonstrating. Yes, we missed it, and in the same situation I would choose to miss it again. She was not in acute danger. The attending had already micromanaged to the point where we weren't going to get to make any read decisions about her diagnosis or treatment anyway. We were really just a glorified babysitting service for her.
When she finally finishes, the nurse of my screaming patient calls and says mom has a bunch of questions and she's going to "escalate" if I don't come talk to her. Are you kidding? Who comes to talk to me when I decomensate as I am about to. I already almost broke into tears inte the middle of the pod with the med students. So, on my way out the door I talk to her, and she's totally calm and reasonable...she just feels helpless and wants to have some control and input into the care of her 3.5 year old boy with only 10 cm of small bowel. That's totally understandable. And why do the systems issues at this hospital make parents feel like they have to fight for what they want. What has created this somewhat advisarial atmosphere? We all want the same thing, don't we? Good Gosh. Systems of management that make you feel that way are crap. It is just so frusterating.
And what does she say when I get to her room? "I thought you'd be gone by now. You look tired." I am tired.
Then one of the attendings sees me finally leaving the hospital at 1:30, "Getting out post call at 1:30--no good." I'm not sure if it's a reprimand or just something to say. Like it's somehow my fault that I'm leaving at 1:30. It's like the collective awareness of the hospital objective and goals and call time regulations is missing. The same attending who showed us all the physical exam at 12:40, then walked out of the room and tried to send two of the med students down to the lab to see a smear of spun down urine and report back to her. I just bowed my head lower over the orders she was having me right to hide the disgust and disbelief on my face. Was this really happening? Does the systems have that little awareness of the pieces that compose it? Finally, our senior stood up for them and said they were post call and would not be able to go right then. "Oh. Well, report back Monday, then." She sounded slightly dissapointed.
This is a time of the new work-hour rules in medical training programs and all the attendings did not have them so many of them have this sort of unspoken aura of, "Back when I trained we worked harder than you all; and I think it's ridiculous that you can't stay all day post call like we used to have to." Whatever.
Plus I feel overall completely underappreciated and superfluous to the whole system. I cannot make any changes to plans without running it by at least three people. It stifles my ability to formulate management plans on my own. When it feels like I am nothing more than a convenient order-writer for what other people have been able to think about and discuss and learn. It feels like it could run very well, if not even better, without us. It's not a good feeling.
Finally, I got out of there, but had to pick up my first paycheck (yep paid only once per month) and they still haven't figured out how to do the direct deposit. So I have to stop at the other hosptial on my way home. I am so tired that everytime there is a red light I close my eyes and nearly fall asleep. My reflexes are noticably slowed and I am trying to be extra deliberate so I don't get in a car wreck.
I figured out how much I make at day, less than $100, and if hourly then it is just about minimum wage. We make less than any other program in the country that I know of. And it costs more than nearly anywhere else to live here. Something is wrong with this picture.
posted by S. at 2:46 PM
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