My team was on long call yesterday, which means we can get new admissions until 6:30 and have to stay until at least 8:00, longer if we still have work to do. (The long call team on any given day takes the post-lunch admissions-- when you're on regular call, you don't get admissions after noon-- and you hopefully get to leave by 6:00 or so.)
Post-6:30 admissions go to the night team. A new admission takes at least an hour to work up, so you really don't want to get a late admission. You will be there longer if you get a late admission. It's unequivocally a good thing that we can't get any new admissions after 6:30, or we'd be there all night.
This is all information just to set up today's post.
The emergency room attending calls me, ridiculously excited, at 8:15.
"I've got an awesome admission for you. Really interesting case. You're going to love it."
"It's 8:15. We're not supposed to take admissions after 6:30. Shouldn't this go to night float?"
"I know, but I wanted to give you first dibs on this guy. He's great. Tons of stuff going on, he's gonna die in like six hours, from any of like nine things. He's great. I knew you'd want this one."
"He sounds like a mess."
"He's totally a mess. It's a great case."
"Look, I have three admissions I'm still working up. I'll be here until midnight if I take a new one."
"I can't believe you don't want this guy. Come on. What's another few hours?"
"I've been here since seven in the morning-- would you think I'm crazy if I said I want to get out of here when I can and go to sleep?"
"I can't believe you're passing up a guy that's going to die TONIGHT. This is what it's all about."
"I've had such a long day."
"Okay, okay, I get it. I'll give it to night float. But, man, you're going to regret passing this one up when you read the notes. Residents passing up admissions, not in my day."
"I'm really sorry."
"Don't worry about it, your loss. I was just trying to save you a good one."
"I appreciate it."
"So if another awesome one comes in later, just straight to night float?"
"Yeah, if it's okay--"
"Yeah, yeah, Rip Van Winkle. Get your precious six hours of sleep."