* * Anonymous Doc

Friday, December 25, 2009

Not a surprise: it is sad to work on Christmas.

It's hard to feel too sorry for yourself when surrounded by sick people, but the entire hospital today was filled with doctors and nurses who didn't want to be there, and it was really hard not to get drawn in to the self-pity. "First time I haven't spent Christmas with my family," "I'm going to have Christmas dinner all alone," etc. I'm a huge downer about almost everything-- and the neverending crush of six days a week, 12+ hours a day is terrible, absolutely-- but it is what it is. For the next three years, we work holidays. Someone has to. People still get sick.

Although not that many people.

It's hard not to start questioning how necessary most hospital visits are when on Christmas Day we got about a fifth of the usual headcount. If 80% of the people usually coming to the hospital don't come if it's Christmas, why are they coming when it isn't Christmas? I don't think there are fewer people getting sick today, or fewer people having accidents. So most of them are just choosing not to come. Why can't they choose not to come every day? And then I could get home at a normal hour.

We had a stupid ethical dilemma today-- for some reason, the orders got mixed up, and a patient ended up getting a doppler of her leg when there was no reason to do it. And the scan showed she has a clot. She also has a history of bleeding, so treating a clot has potential complications, and may also interfere with our treatment of what she's actually in the hospital for.

So the resident's first inclination was to pretend we didn't see the scan. The scan was never ordered, it shouldn't have been done, there was no medical reason to do it, and if it hadn't been done, we would have never known about the clot. .....

Except of course that's not really in the best interests of the patient (even though it's easier) and we can't put the genie back in the bottle. We know she has a clot, we have to figure out a way to treat it, and balance all of the patient's issues as best as we can.

The resident realized we couldn't just ignore it, called the attending, and even though it took an extra hour, we figured out what to do.

If the clot was going to cause a pulmonary embolism, then this accidental scan very well could have saved the patient's life. This should scare you, as a potential patient. A life possibly saved, by a scan that no one ordered, that just happened to accidentally get done. Perhaps appropriate on Christmas-- perhaps this patient's Christmas miracle.

Not to get too caught up in fate and a higher power. But, really, it's almost enough to be okay with having to work on Christmas.

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