Wednesday, December 18, 2013

Worst Rehab Call

This is the story of my worst call as a rehab resident. If you only enjoy happy stories with no complaining, then you should probably stop reading now. (Actually, if that's the case, why are you reading this blog in the first place?)

I hadn't been dreading it that much. I was on home call Friday night, Saturday, and Saturday night, which is better than Saturday and Sunday at least. I was stuck with the slowest attending, Dr. Blabber. Most of the time, Saturday rounds are maybe from 8 to noon (or at worst 2 or 3), but I had a bad feeling it might be longer. I was also about six months pregnant at the time.

I got called at around 2:30AM Saturday night about a patient who had just been transferred over from medicine that day. He was one of those awesome patients who had just had bypass surgery and was horribly unstable, now sitting in a rehab bed. His name was Mr. Nguyen (not his real name) and he spoke no English. And he was having chest pain. I called a mini-Code.

Off to the hospital I went. I called medicine to come help me and fortunately got the resident who had transferred the patient to rehab. We did the whole EKG, enzymes thing and everything was normal.

At that point, I had given up on getting a good night's sleep at home, so I decided to stay at the hospital. I went up to the call rooms, except rehab had no dedicated call room and most of the rooms had threatening notes on them saying that they would cut anyone who they found sleeping in their call room. So I picked the med student call room, thinking that this was the one population in the hospital who had less power than me.

Sleeping was not an easy task. At six months gestation, I had two positions I could sleep in: my right side and my left side. Except on Friday, I got a flu shot in my left arm and that was hurting a lot, so it was hard to sleep on my left side. So I had exactly one comfortable sleeping position. But as you may know, if you're a human being, it's hard to stay in one position all night. And in the miracle that I was actually able to drift off for a minute, my pager would wake me up.

I had asked Dr. Blabber when she wanted to meet on Saturday morning. She told me 7AM. She said she knew this was earlier than normal, but she thought that getting an early start would help us get out of the hospital earlier, which I totally agreed with. So I showed up to the trauma center at 7AM and got a bunch of crackers for breakfast (yum). By 7:10AM, Dr. Blabber hadn't arrived yet, so I told the nurse to start giving me report.

At 7:30AM, Dr. Blabber still hadn't arrived. I finally paged her. She said that she was listening to signouts on her answering machine and then she wanted to get breakfast. So what the fuck was all that about an early start???

I finished getting signout and went to the cafeteria to meet Dr. Blabber. Unfortunately, she seemed to have no interest in having a quick breakfast and getting to work. She wanted to bullshit with me, mostly about how cruel internal medicine is to residents (as the day went on, this became increasingly ironic). And on an unrelated note, this woman spread PEANUT BUTTER on her pancakes and then covered them with syrup. What sort of psychopath eats pancakes like that???

Around 9AM, we made our way down to the trauma center. I was bitter that I could have slept an extra two hours, but I tried not to think about it. I figured that at least since I had gotten signout, things would move faster. But no. Dr. Blabber basically rewrote every single one of my notes verbatim, which took another half hour.

At 9:30AM or so, we FINALLY started seeing patients in the trauma center. I figured since there were only six patients and none of them were sick, it should go fairly quickly. I don't know why I kept being so naive. The thing is, Dr. Blabber LOVES to talk to the patients for as long as possible. Our first patient:

Dr. Blabber: "How are you feeling today?"
Patient: "I'm fine."
Dr. B: "There's nothing that's bothering you that I could help you with?"
Patient: "No."
Dr. B: "Nothing at all?"
Patient: "Not really. Well, I am still having some nausea."
[Twenty minute discussion ensues involving remedies for nausea, including sea bands and ginger ale]

Dr. B: "Also, what color are your eyes?"
Patient: "What?"
Dr. B: "What color are your eyes?"
Patient: "Uh... blue."
Dr. B: "Well, you know what? Your eyes are going to turn brown soon."
Patient: "What?"
Dr. B: "Your eyes are going to turn brown."
Patient: "What?"
[Twenty minute discussion ensues about how it's been two days since patient took a crap]

By 10:30AM, we had managed to see two patients. We saw two patients in an hour. That's fine, except we still had the rest of the hospital to round on with about SIXTY patients. At that rate, we were set to finish rounding about..... 4PM the next day.

We also had an admission. OMG, acute REHAB admission on a Saturday!! This patient needs physical therapy STAT. Give me 20 cc of ankle foot orthoses!! Actually, the admission turned out to be a blessing, because I left to do the admission and was freed from the agony of Dr. Blabber telling every patient how their eyes were turning brown. Also, since the new patient was aphasic (can't talk), I figured even Dr. Blabber couldn't spend more than 10-15 minutes talking to her later.

I took my time with the admission, thinking I'd let Dr. Blabber finish seeing some patients on her own. I had honestly expected her to move on to a different floor at least during the hour and a half it took me to finish the admission, but she only managed to finish seeing the patients in the trauma center. Three hours for six patients. 56 patients left to go.

At noon, she came over to see my patient. She made me present to her in like two seconds, like she didn't have time to hear the whole story. Then she barely even saw the new admission, even though she spent FOREVER seeing the patients who had been there for months. I couldn't criticize though, because I thought she was finally going to get serious about rounding and maybe we'd finish at a reasonable time. She also told me to get lower extremities ultrasounds on the patient, which I wasn't going to do since she had been on prophylactic heparin (more on that later).

We started rounding on the next floor of patients (there are three floors total). Unfortunately, I had been totally wrong about picking up speed. We were going just as slow as ever. And every patient's eyes were turning brown.

By 1:15PM, we had only seen a handful more patients. I finally said to Dr. Blabber: "If I don't get lunch in the next few minutes, I'm going to faint."

I was really hoping she might continue rounding while I went to get lunch, but she wanted to come with me and sit with me. I was so angry at her though, I didn't say a word through the whole meal. I got meatloaf, which I thought was covered in onions but it was actually covered in BACON. Ew. I just don't believe in meat being covered by other meat. I ate a few bites and was promptly completely grossed out.

When I finished, I said to her, "Okay, are you ready to go back?"

"Not really," she said with a long, drawn out sigh. Like she was so tired. Uh, between the two of us, which one of us had been in the hospital since 2AM?? Which one of us was growing another person inside them??

And which one of us was taking freaking forever to talk to every single patient? You want to move faster? Then MOVE FASTER! It's not like I had any control of the situation.

We went back to that same floor. It was almost 2. I felt like we were never going to finish. And I was getting calls from the next floor... they were confused because they didn't know why we hadn't come down there yet to round. As I said, most attendings were done by no later than 2. I had to break from rounds for a good half hour to deal with a guy on another floor whose suprapubic catheter was leaking and when I came back, Dr. Blabber was still with the same patient as when I had left. And not only that, the patient was a medicine patient who we weren't even supposed to see!!

At about 3:45PM, we were halfway down the final hallway. One of the orderlies came up to Dr. Blabber and put his arm around her, "What do you look so sad about? You're almost done."

"We still have another floor to go to," Dr. Blabber said.

"Really??" the orderly looked astonished.

"Stop talking about it or else I'm going to start crying," I said. I wasn't kidding.

I was beginning to feel like I couldn't take another second of this endless rounding. It was horrible. Plus my feet were killing me from standing so long and my legs were swelling up. Finally, I said to Dr. Blabber: "I feel like my heart is pounding in my chest."

"You do?"

I held out my wrist and she took my pulse. "It's 126," she said. "Go get some water and sit down."

I really felt pretty crappy. I hadn't slept last night, I was six months pregnant, and I had been standing nonstop almost all day.

Dr. Blabber finished up on that floor, miracle above miracles, at around 4. She told me she was going downstairs to the final floor and I said I'd go with her.

We got to the first patient, who was possibly the sickest one on the floor. We all surrounded his bed and started asking him about his leaking catheter, although I tried to stay in the periphery.

"Wow, you look tired," the patient said, looking at me.

"Hmm?" Dr. Blabber said.

"She looks really tired," the patient said.

"Who do you mean?" the nurse asked him.

"He means me," I said.

Around that time, I got a call that my new admission had a HUGE deep vein thrombosis in her leg. I was actually not that upset, because it gave me an excuse to call radiology to put in an IVC filter. I thought I'd get to escape from rounds for a little while, but I hadn't counted on Dr. Blabber sitting down next to me and staring at me as I made all the calls. Um, I think I can handle asking IR to put in a filter. I don't need to be supervised, thank you very much.

I tubed upstairs the orders for the filter to be placed. Unfortunately, I forgot to write the phone number for the patient's husband (who had to give consent) on the form... and even though I had told radiology that phone number, I thought it would be best to have it on the form.

I called the second floor: "Hi, did you get the form I just sent upstairs?"
Charge nurse: "Yes, we did."
Me: "Can you write a phone number on the form for me?"
Charge nurse: "I can get the patient's nurse if you want to give a verbal order."
Me: "No no no, I just want you to write a phone number on the form. Not a verbal order."
Charge nurse: "Huh?"
Me: "On the form, just write the phone number--"
Charge nurse: "Hold on, I'm going to get the patient's nurse so you can give a verbal order."
[I wait for several minutes]
Nurse: "Hello?"
Me: "Hi, are you the nurse for Mrs. G?"
Nurse: "I don't know. Let me check."
[I wait several more minutes]
Nurse: "No, I'm not. Do you want me to find out who it is?"
Me: "Forget it, I'll come upstairs."

So much for saving time by tubing something. I was actually glad to escape from rounds for even longer though. I was unfortunately unable to locate the patient's nurse, but they told me that since it was 5:30PM, the patient hadn't eaten yet, so I made her NPO for the procedure. I then had to contact the husband to get consent, which wasn't easy (even though he had told me that he'd wait by the phone in case we needed to do this procedure). He also told me that he was a MALPRACTICE ATTORNEY, which made me feel so much better about all of this.

Long story short, I got the consent, rewrote all the patient's orders (for some odd reason, this needs to be done if a patient goes for a procedure), and made sure she was all set to go for the IVC filter.

I got back to the first floor at around 6. I had hoped Dr. Blabber was almost finished and by golly, she was (almost finished). She had one patient left. The nurse gave me a list of all the orders that Dr. Blabber had failed to write while rounding and I wrote them all, plus some stuff that had been in our signout that she had never done. How is it possible to be so slow, yet miss so much?

I came in with her to see the final patient. It was a spinal cord injury patient and her husband. The husband was sitting right by the patient's bedside.

Dr. Blabber: "Hi, I'm Dr. Blabber. I'm covering for the weekend. How are you doing today?"
Patient: "I'm okay."
Dr. B: "Any problems?"
Patient: "No."
Dr. B: "Are you sure?"
Patient: "Yes."
Dr. B: "I got the results of your spine X-ray and it showed..." [ten minute discussion of the results of the X-ray]
Patient: "Okay."
Dr. B: "Do you have any questions?"
Patient: "No."

At that point, I was psyched that we were going to leave. But then Dr. Blabber turned to the husband, who as I said, was sitting right next to the patient.

Dr. Blabber: "Hi, I'm Dr. Blabber. I'm covering for the weekend. How are you doing today?"
Patient's husband: "I'm okay."
Dr. B: "Any problems with your wife?"
Husband: "No."
Dr. B: "Are you sure?"
Husband: "Yes."
Dr. B: "I got the results of your wife's spine X-ray and it showed..." [ten minute discussion of the results of the X-ray]
Husband: "Okay."
Dr. B: "Do you have any questions?"
Husband: "No."

I was like, Am I on crazy pills here??? Why did she have to have an identical discussion with two people who were sitting right next to each other????????

But at that point, I was beyond caring. It was 6:30PM, I had been in the hospital for about 16 hours and I was very ready to go home.

Practically the second I got home, I got a page: "Doctor, I'm worried about Mrs. G getting the IVC filter placed because she ate dinner."

"But I made her NPO!!!!!!!!! There was a sign on her door!!!!"

At that point, I started crying. Literally. I was practically hysterical. I cried and cried. I used to cry after almost every medicine call, but I really thought I was past that. But somehow, they broke me. I kept crying that I didn't want to be a doctor and that I wanted to throw my pager out the window.

While I was crying, I got another page. I calmed myself down and called back: "Mr. Nguyen had a large bloody bowel movement."


"It's frank blood."

His vitals were totally stable so I had them place a second large bore IV with a fluid bolus, got a stat CBC, type and cross. I called Dr. Blabber and she didn't have anything else to add.

I was debating if I should go back to the hospital again. I really didn't want to. Then I got another call: "Doctor, Mr. Nguyen just became unresponsive and coded. He's responsive now."

I got to the hospital just in time to wave to Mr. Nguyen before they whisked him away to the ICU.


  1. Thank you for this hilarious account.I know you were crying but I was laughing almost hysterically. The pancakes, crazy pills, and beyond caring...Pearls.
    P.S BTW been on call and pregnant, done that.

  2. Brilliant, Fizzy. More of these please.

  3. OMG & I thought having to read a 4 line stupid MCQ scenario & find the answer in less than 30 second is crazy.
    So it is true things just keep getting worse.
    And we are hooked up by our social obligations, family pressure & bride and decide to continue & move on.
    It is not a crazy medical life, we are plain crazy.

    *jump out of the window*

    1. @peace: Yep, you've pretty much got it right that things just keep getting worse. I recently heavily considered quitting, but my fiancé helped me to see that with just 6 months of residency remaining I've got to stick it out. I've always done well in school and residency, but I'm feeling burned out mainly due to medicine's high patient volume and ever-increasing (yet unpaid) administrative burden. However, while being a doctor is not great, not being a doctor is worse. If I had another amazing skill I might prefer to put it to good use. Good luck to you.

  4. I want to go back in time and punch Dr. Blabber for you. I'm sorry.