Sunday, November 23, 2008

Consult Rage
I had my first bout of consult rage last week. It is sort of like road rage but instead of wanting to tap on the window of some horrible or overly aggressive driver and ask them what they could possibly be thinking, it makes you want to call up a doctor and ask them where they went to medical school. It probably didn't help that I was called to see they particular patient just before I should have been sent home.

I was on call for neurology and was asked to see a guy in his mid-60's (details have, of course been changed to protect anonymity). He had been in a car collision a couple of days previous after blacking out (most likely syncope from 3 different hypertension medications) and running a red light. He had come to emerg and check out fine. The next day he saw his family doctor and promptly sent back to emergency for left sided "weakness". He was seen by neurosurg, had a head CT and C-spine x-rays and had been signed off.

And yet they still consulted neurology. I can only presume that they thought this left sided "weakness" was due to a stroke. Except he did not have weakness and never did. English was his second language and when he said weakness he just meant he couldn't use that side properly due to pain. This took me all of 30 seconds of extra questions to figure out. On motor testing the strength was fine, just limited by all the bruising from the collision. So neurology was consulted on a patient already deemed healthy by neurosurg that had no neurologic symptoms.

I might not have been so upset except for the extra hour (mostly spent waiting to review first with the resident and then with the attending) it kept me away from home.

On the up side that patient thanked me for being the nicest doctor he had seen in the 26 hours he had been in emergency.

Monday, November 17, 2008

One week down, 25 to go
I am now into my second week back at clerkship. Things are as well as can be expected. Most people seem to be a mix of impressed and horrified when they hear I have returned with a two month old at home. Most relax noticably when they hear that I left my little guy in the care of his father. (I am not sure what terrifying alternative they were imagining.)

After some initial getting-to-know-each-other-and-the-bottle adjustments the guys are doing well. The little man learned smiling a couple of weeks ago and is making great strides in his laughing, which is probably the best way possible to come home. It also isn't so bad to come home to a hungry baby I can spend a little time comforting either. Right now I am writing in the doctor's lounge, 4 hours past my longest time away from him. He will probably be in bed by the time I get home so I am actually looking forward to tonight's 2am feeding.

I can't say that I was an all-star clerk last week, I tend to be much more of a go-getter. But no-one died or was neglected and things are more on track this week. I have been more on the ball at the bedside grill sessions and am trying to work my way into presenting at grand rounds on Friday.

New pictures will have to wait until I am on my own computer.

Wednesday, November 05, 2008

Returning to the grind

I am in the middle of my last week of leave. In 4 short days I return to clerkship.

Just about everyone asks me if I am looking forward to it or dreading it. Of course I am dreading leaving my son for 8-12 hours per day. It is not like I am leaving him on a doorstep or sending him down the river in a reed basket. He will be at home with his very capable dad. But I won't be there to see him learn every new thing or check his stool.

I am also dreading trying to pump 3 times a day while at the hospital. I am not sure if there is anywhere half decent in the hospital to do this. And, as a clerk, I have no control over my time. It will be an interesting challenge.

But I am looking forward to getting back to medicine. To having adult conversations. To learning new things myself.

Of course another pic of the little lad; in a onesie from his aunt.