The rotation I'm on right now is a little too slow.  I know, they're either too busy or too slow, there's never anything in between that's just right.  I told the med student who's on my team to bring a book, there's just nothing to do.  I have seven patients, but only two of them should even be in the hospital, the rest should be in a nursing home.  I passed a patient lying on a gurney in the hall.  He moaned, "am I on your list?"  I said he wasn't.  "People go to this place to die," he said, as I went to check his chart.  No one had written a note on him in two days.  I don't know whose patient he is or why they left him in the hall.  I found his room, took him back, paged the resident who'd last seen him--
It's bizarre to go to the different hospitals in the system and realize the differences.  Same doctors rotating through, but a different facility, different patient population, and different standards.  If you need a scan here, it has to be a Monday or Thursday or it's not happening.  Scans happen on Mondays and Thursdays.  You need it on Tuesday, you're probably waiting until Thursday, emergency or not.
I went into one patient's room, I'm asking him about how he's doing-- and his roommate answers from behind the curtain.  "I'm talking to Mr. [Patient], your doctor will be with you later."  No matter, he just kept talking.  I ask the guy how long he's been married.  The roommate answers.  I ask how his leg is feeling.  The roommate answers.  This would be merely annoying, except-- the patient has dementia and we haven't gotten a real answer from him since he came in.  Somehow, he must have had a few moments of lucidity and had some sort of wide-ranging conversation with his roommate, where he told him about his family, about his medical problems, about his hobbies-- the roommate knew everything, we don't know anything, we've never been able to get a sensible answer out of this patient.
I have one patient, an African-American guy-- I feel bad for him-- he knows what year it is, he can count to ten, he knows the alphabet-- but he doesn't know who the President is, and when I say Obama, he just stares blankly, it doesn't ring a bell.  He's probably been waiting 80 years for a black president, and now that we have one, he doesn't even know it.  I know the mind doesn't work this way, but you'd hope something like that would have stuck.  It's unfortunate.
Monday, November 23, 2009
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