"It's too bad he's not demented. He'd get so many more services."

Phone rings--

"I'm calling from [False Superlative] Home Care Agency about your patient, Mr. Homebound.  We're trying to arrange the appropriate services."

"Great, I'm happy to send you over whatever records you need."

"We had a few questions.  Is he able to walk at all?  We were told he's able to take a few steps."

"No, he has not been able to walk ever since they had to amputate his leg below the knee."

"Oh, the amputation wasn't mentioned by the patient.  It just says here he had surgery for an infection in that leg and that it was removed."

"Yes, it was removed.  Amputated."

"Oh, we were under the impression that the infection was removed, not the leg."

"Okay, glad I could correct you."

"Also, is the patient able to answer questions?"

"What do you mean?"

"How is his mental functioning?"

"He's fine.  He's physically limited, but mentally he's fine."

"You're sure.  No dementia at all?"

"No, no dementia."

"Not even a little?"

"No."

"That's really too bad.  He would qualify for so many more services if he was demented.  It's really a shame he isn't demented."

"I don't imagine his family feels that way."

"No, they want as many services as he can qualify for.  And he would get more if you were able to say he was demented, even a little bit.  So, if you don't mind, I'll ask you again.  Is he demented?"

"No."

"Maybe a little forgetful?  Could we say forgetful?"

"No. What did you say the name of your agency was?"

"[False Superlative] Home Care Agency."

"And your name specifically?"

"Oh, I'd rather not give that out.  If we can just continue.  I'm going to write down that you're not sure about his mental status."

"No, I am sure.  I saw him three days ago as an inpatient, and he is not suffering from dementia."

"I'll have someone do an evaluation."

"I'm just going to have the assistant here fax you the records, okay?"

"Well, I was also hoping you could call in a few prescriptions for supplies."

"What supplies does he need?"

"Gauze.  Tape.  Oxycodone."

"Mr. Homebound is not on oxycodone."

"But in case he needs it for the pain."

"Nope.  I'm faxing you the records. Goodbye."

"Please leave a message..."

I call a patient and get her answering machine:

"You have reached [name].  You can leave a message but you must speak very loud and very slow.  I do not hear well, so you need to talk very clear.  You can spell things, but I do not spell well, so I may not understand.  You should also call back when I am here, since sometimes I forget to check the machine.  If this is my daughter, I can't hear you when you call from the car.  Everyone should wait for the machine to do a beep.  Thank you for calling."

I left a message, but I guess I'll probably try her again tomorrow.

Emergency, or not?

We're on call for our own clinic patients overnight during the week. So if one of my patients calls the answering service at 2 AM and says it's an emergency, I get paged, woken up, and call them back. This is an unfortunate but necessary hazard of the job in cases of actual emergency and a terribly frustrating driver toward my own personal insanity in cases of obvious non-emergency. It is often terribly difficult to get back to sleep after you are paged, and terribly difficult to get patients to understand you are a human being who they are actually waking up if they call at 2 AM and claim emergency.

I get that sometimes it is difficult to distinguish a 2 AM emergency from a non-emergency.

But if your emergency involves the need for a medication refill, it is not an emergency.

If your emergency involves a question about your recent lab results, it is not an emergency.

If your emergency involves a desperate need to reschedule your next appointment, it is not an emergency.

If your emergency involves a pain you have had for a period of time you are describing as some number of weeks, it is not an emergency.

If your emergency involves your son, your daughter, your aunt, your friend, your dog, or anyone else who I've never met before and isn't my patient, it may well be an emergency, but for purposes of calling my answering service and telling them to wake me up at 2 AM, it is not an emergency.

If your emergency involves any type of question that begins with the word "Hypothetically," it is not an emergency.

If your emergency is only an emergency because you are worried you are going to forget your question if you wait until the morning, it is not an emergency.

If your emergency is a complaint about someone you dealt with, either in the clinic, another medical facility, or your local supermarket, it is not an emergency.

If your emergency involves the dream you just woke up from, it is not an emergency.

If your emergency is about the same thing I have already told you fifteen times is not an emergency, it is not an emergency.

If you are going to forget your question in the time it takes for the answering service to page me and for me to answer the page, please, it is not an emergency.

And, finally, if your emergency is about having missed the confirmation call about tomorrow's appointment and wanting to make sure I know you will coming to see me, no matter how good your intentions are, at 2 AM, I assure you, it is not an emergency.

Hurricane.

I've been exchanging e-mails this past week with a few friends in New York, doing their residencies over there. And it seems beyond crazy. You think that-- despite the hours and the stress-- at least your job as a resident is secure. Barring something truly awful, you don't lose your job as a resident. And then your hospital floods. And it closes for weeks. And you... might still get paid.

Maybe not. Who knows. I know people who were at NYU, carrying patients down dark stairwells after the power went out, trying to keep track of patients without access to their (computerized) patient records, without monitors, without CT scans or x-rays, without anything. Patients with life-threatening conditions barely getting care. None of us are trained for third-world medicine. We barely know how to take blood pressure without a machine. Scary over there. Seriously scary.