I did eight admissions overnight. This probably sounds terrible, but there's something relaxing about knowing that on this rotation I just have to admit the patients and don't need to follow them at all-- I never see them again once I do their initial workups and write their notes. If I make a mistake-- and I'm not saying I'm making any mistakes-- I'm not the one who has to deal with it.
What I don't think most people realize is that mistakes happen all the time. When I was on the regular floors, on the day team, it was not unusual to come in and find a new patient who had been completely mismanaged overnight. Wrong tests, wrong medications, wrong treatment plan. Hopefully not with any adverse consequences-- usually it just meant we had to start from scratch-- but there aren't really any checks and balances overnight. I'm given a patient, I do the workup, if I don't ask for help, it's assumed that I know what I'm doing and everything's fine. No mistake would be discovered until the morning. Unless it's some severe mistake that leads to a rapid response, in which case it's probably too late anyway.
A commenter on the last post said I was whining too much. And he (or she) is probably right. Compared to almost anything else I could be doing with myself, this isn't so bad. Even among things that fortunate people get to do, this is still pretty good. I'll make a good living, I'll be pretty well insulated from anything going on with the economy, I'll sound like a legitimate person at cocktail parties. But that doesn't mean it's not exhausting at times, and overwhelming, and frustrating, and sad. It can be all of those things in the moment-- and I can feel that while still knowing in the macro sense that I'm quite lucky.
There's more humor on the outpatient side, sure. And having not had regular clinic hours in a while, perhaps I've gotten a little dark over here. Clinic starting again soon. For now, all I've got is my patient last night who's doing a tour of the local emergency rooms.
"I was at County last week, then State over the weekend, and University on Tuesday-- they all said I didn't need to be admitted, and should follow up with my primary care physician, but I still wasn't feeling right, so I thought I'd come back and try you guys."
"Yeah, you still just have a cold."
"But I feel like I'd be more comfortable in the hospital than at home."
"Yeah, but we're not a hotel."
"I can't just stay for a couple of days, ride this one out?"
"You know of any hospital that might be more willing to let me stay over?"
I would have called social work for a consult... but it's the middle of the night. I gave him the number for social services-- I don't know, he doesn't really have a medical problem, but I sense he'll be back.
And now... sleep.