What Goes Around

The other night on my last call with my experienced end-of-the-year interns before the brand-new-med-student-one-day-doctor-the-next batch started we admitted seven patients.  Since I had a new acting intern (a fourth year practicing being an intern) in addition to my two interns, one of them would have taken three.  Which is normally how I would have divided patients except for one thing.  Except for one patient.  He was a resident, too.  The ER physicians told me about him on the sly and after I staffed him and the rest of the early patients with my attending by phone, I turned around to see him sitting there, hunched over his own history and physical form, "I guess you're admitting me," he said, "I thought I'd just fill this out for you."  

"You don't have to do that," I took it from him and took his history right there in the Doc Box of the ER.  He was on call.  He kept getting paged and wanting to go help with the pelvic fracture trauma with the intestines spilling from the vertically split pelvis (don't ride motorcycles, kids).  I told him I'd have to do an exam, too but that we would wait until he go upstairs in a room.  I got him a private room.

It was oddly familiar from the other side, being admitted to the same hospital where you work, being taken care of by colleagues who you see every day or week--residents on a different service, but still in your field--in the field of medicine.  Taking care of our own. Reminded of our own mortality.  

What he has could have been serious, but from the beginning, it probably wasn't anything bad long term.  It was something that would stop him from working for a while but it is a disease that starts with "acute" not "chronic."  It won't follow him around medically--only in hospital lore.  His team rounded on him.  Every time I had his information pulled up on the computer, one of his co-residents would look over my shoulder and tell me how odd that was to see his name there. 

He paged me today to let me know he was feeling better and asking to go home.  I'd anticipated this and had already passed it by all my powers that be. His stay was less than forty eight hours.  He started to do his own discharge summary on his lap top; I told him I would do it.  It wouldn't take long.  I wouldn't even have to dictate his discharge summary since his stay was so short.  This morning when I tried to round on him, he was sleeping, curled up in the small hospital bed with his girlfriend (a student, bartender and food server).  I didn't wake them, but I remembered when Steve stayed with me all those days when I was in the hospital.  That part seems like another lifetime--him being there--me being there.  

Thinking of him there, I remembered how every lab value was a needle stick, how every set of vital measurements was a middle of the night wake up,  how every measure of urine was pee in the ridiculous toilet hat,  how every movement would be limited by the iv pole (though his only had normal saline, instead of medicine to keep him from stroking more).  Last night when I got home, I spent hours on the computer reading about what he has.  And I entered an order:  "Okay for patient's iv to be hep-locked when out of room."  Then he could be freer than I had been.  I had to take mine with me to the shower.  He wasn't there long enough to need a shower. 

My attending had said that one of the interns could take care of him.  It was true.  It would have saved me some work and effort and note-writing and pre-rounding.  But I'd been on the other side.  Hospital morning consisted of being woken up first by the phlebotomist, then the med student, then the intern, then the resident, then the consult service resident, then the other consult service resident (by this time clearly one was already very awake) and then the whole teams with the attendings came around and filed into the room where you lay in be at a serious height disadvantage.  Steve stayed with me then.  I didn't care what they thought about him being there then, but I do wonder now.  

At least if I took care of him by myself it would save him some hassle and some morning awakenings.  Plus I didn't know how well the new interns would do.  They're overwhelmed by the logistics still.  

And I'd been there.  I thought of him all night.  I remembered when all my doctors got to go home at the end of the day and I watched them leave from my window or from the bench outside with my iv pole standing century above me. I thought of him lying in his hospital bed and I remembered being there.

When I discharged him today, he thanked me profusely, and repeatedly.  It was a team effort--taking care of him--I was just the coordinator, the learner, the detail person.  But I had done a good job.  I'm getting better at this doctor thing day by day.  And I remember being on the other side of it.  I remember the patient thing, too. 

Tonight he has dropped off my patient list, which means he is home.  Probably still nauseous, using the sublingual zofran I gave him, hopefully eating better, but he is at home.  As am I.  

Tonight I made Trader Joe's seafood stew and baked bread and muffins and drank tea.  I walked up and down stairs (which I could not do with an iv attached).  I didn't have a headache.  My knees hurt only a little.  I talked to Victor, who told me he'd overhead my new interns say "how much they liked me and how awesome" I am as their resident.  I try.  I learn.  I am alone.  I am still a doctor; I am home; and I am alive, which, at certain points last year, are more than I expected.  

Room 1123.  Ten days.  What goes around, goes around and around and around.