*beep*beep*beep*.....

[fongool]

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no kidding -


3 AM at the VA
"Mr. ___ says his balls itch. Can you come look?"

Click...

2 AM at our peds hospital from a peds intern
"What's the difference between tonsillitis and pharyngitis?"

Click...

 

[Winged Scapula]

But didnt he have sex with her before she had the child?

Also, I dont think having a child is enough to be emancipated. Check with your legal advisors.

Well, I assume they had sex before she had a child. And I asked several times, including the Social Workers who should be well-versed in the Child Protection Laws and was told the same thing - of course, I didn't verify the answer with an attorney or police that once she has a child she becomes an adult and they can't prosecute him. It never made sense to me either.

But since it was nearly 2 years ago, it doesn't make much sense for me to check with my legal advisors at this point, but thanks for the input.

 

[BurnOnMyYeeeow]

Paged by medicine at 11 PM.

Flea: Hi, my attending would like a consult for a PEG and a port-a-cath.
Me: You're calling at 11PM for this?
Flea: Well, he wants it...right now.
Me: Right...now?
Flea: He wants the patient to start chemo tomorrow and he also can't swallow and would like the patient to also get a good night's sleep.
Me: Does he want fries with that?
Flea:...
Me: He can add a cookie for only 99 cents, would you like to try the cookie today?
Flea: Whu-....
Me: Well?...
Flea: I-...don't understand.
Me: If he wants to order something and get it in a few minutes at this hour, , tell him to go to Jack in the Box, they're open 'till midnight.
Flea: Who's your attending? It appears we will simply bypass you.
Me: Fine, it's Dr. X

In the AM:
Dr X: Slaps me on the back. Want fries with that? *gales of laughter*

---------------------------------------

2AM consult, Ped surgery
Me: Hello, surgery consult.
Peds resident. Hi, we'd like a broviac on this kiddo...
Me: At 2AM?
Ped: No, first case will be fine.
Me: You called 2AM and need it first start, why?
Ped: He needs to get chemo starting in the afternoon.
Me: And you decided this just now?
Ped: Babbles excuses. Finally, it comes out, she forgot. She was supposed to call the day before.
Me: Your inability to plan does not constitute an emergency for us.
(My attending had authorized that to use that line before hand: the 2AM broviac consult was a fairly frequent occurrence).

---------------------------------------------
Page answered. I'm in the OR with the attending doing an appy in the middle of the night and just finished.

I dial by speakerphone so I can keep writing orders etc.

Me: Hi, surgery resident on call
Dr: Hi, I'm Dr. X, I'm at YYY hospital. I just did a bowel resection on an infant with NEC, and would like to know if you have any advice for me and if I can transfer him to your small bowel transplantation program?
Attending seizes the phone off the cradle.

Attending: How much bowel did you resect?
(Turns out the answer was: from pylorus to rectum).

Attending: I see. Advice? Hire a malpractice lawyer. And in answer to your second question: WHAT small bowel transplantation program?

All true, sadly.

 

[Winged Scapula]

...Me: Your inability to plan does not constitute an emergency for us.
(My attending had authorized that to use that line before hand: the 2AM broviac consult was a fairly frequent occurrence).

Same experience here with the same line given...I used to LOVE that. Of course, our attendings were not so supportive. In private, they would complain about the Heme-Onc team's lack of planning or getting stuff done in a timely fashion, then demanding a stat line. Publically, it was all kiss arse.

 

[pillowhead]

---------------------------------------------
Page answered. I'm in the OR with the attending doing an appy in the middle of the night and just finished.

I dial by speakerphone so I can keep writing orders etc.

Me: Hi, surgery resident on call
Dr: Hi, I'm Dr. X, I'm at YYY hospital. I just did a bowel resection on an infant with NEC, and would like to know if you have any advice for me and if I can transfer him to your small bowel transplantation program?
Attending seizes the phone off the cradle.

Attending: How much bowel did you resect?
(Turns out the answer was: from pylorus to rectum).

Attending: I see. Advice? Hire a malpractice lawyer. And in answer to your second question: WHAT small bowel transplantation program?

All true, sadly.

Oh my goodness that is horrendous! Any chance you know what happened to the child?

 

[MediCane2006]

Your inability to plan does not constitute an emergency for us.

Great line. 👍

Seriously, though, isn't it basic professional courtesy not to pull stuff like that when consulting another service?

 

[Winged Scapula]

Great line. 👍

Seriously, though, isn't it basic professional courtesy not to pull stuff like that when consulting another service?

Sure...but it happens ALL the time. Residents often have very little professional courtesy, especially at the junior levels, for each other. Sometimes it to C*their*A (as in the example above), sometimes is just forgetting what time it is or the possibility that others might be sleeping or even just considering that the consult can wait until morning. I can recall being an intern on Trauma and starting to call consults, order tests, etc. when rounds were done...forgetting that it might only be 0630 and most people (ie, social workers, physical therapists, etc.) without a resident's job, are home in bed at that time. Attendings are usually different and you won't generally find them calling each other at 0200 for something that should have been done earlier or can wait until daylight.

Some consults are not called by physicians (which I consider a real no-no) but the order is written in the chart in the evening and it gets taken off and called by a nurse or ward clerk hours later. If you have the gall to not call your own consults, please at least make a note in the order that the consult can be called in the morning (after 8 am, which is when most medical services change teams), unless of course its urgent.

 

[MediCane2006]

Some consults are not called by physicians (which I consider a real no-no) but the order is written in the chart in the evening and it gets taken off and called by a nurse or ward clerk hours later. If you have the gall to not call your own consults, please at least make a note in the order that the consult can be called in the morning (after 8 am, which is when most medical services change teams), unless of course its urgent.

Totally hijacking the thread....

...but this KILLS me. Seriously. If I need another service's opinion on my patient, I call the other practitioner and give them the relevant background information and the specific question(s) that I'd like their advice on. I expect the same courtesy in return, but for some reason it seems acceptable to some people to have the nurse or medical student call with a vague request and no idea what the pertinent issues are. And the sad thing is that the poor nurse or MS-3 gets the ire of the consultant, when they're just doing what they're told. Residents that put their nurses/med students in this position...👎

Anyway. Back to the topic at hand.
BEEP BEEP (10 AM on a lazy Friday at the VA)
Me: Hi, surgery returning a page
Med resident: Hi, it's medicine. So we've got this guy who came in yesterday with belly pain.
Me: Uh...okay
Med: He hasn't had a bowel movement or passed gas in a week and he says his belly hurts
Me: How's his exam?
Med:He's a little distended, I guess. We got a CT yesterday.
Me: ....and....?
Med: Well, I'm looking at the reading this morning. And it says there's air.
Me: FREE AIR!?
Med: Uh. Yeah, I guess so.
Me: This scan was done WHEN? (heading down the stairs while I'm talking)
Med: Yesterday afternoon, but the read only popped up today. We were wondering if you guys would come see him. The radiology report said, consider stat surgical consult.

This poor guy was blown up like a tire. We put an NG tube down, while en route to the OR, and got back stool. Our lazy friday turned into a stat ex-lap (and since the senior had already gone home for the day, it was my case 😀 !!)Turns out he had an obstructing left colon ca and had blown out his cecum. And the CT in question? The abdominal organs were squashed, there was so much air.

God bless radiologists, but always read your own films, boys and girls 😉

 

[Winged Scapula]

Gotta LOVE the VA...without in-house rads after hours.

Gotta LOVE medicine residents who don't read their own scans.

Gotta LOVE residents who take their time calling consults.

I have had the exact same happen at the VA - CT from the day before, no one looked at it after hours, read went to telerads, and the in-house medicine team didn't look at the scan or for the report themselves until the next day. Not sure if anyone was called with the report. Our guy died.😡 (of course, he was a medical nightmare without the surgical issues anyway).

Back to regularly scheduled programming...

 

[danielmd06]

Nurse: Uh, yeah. I was wondering, your order says strict Is and Os for Mr. Slimebag in Room 4235. Do I have to include semen?

Me: Huh?

Nurse: Well, I caught him having sex with his <underage> girlfriend again and was just wondering if I have to count his, you know <whispers and spells> c-u-m, in his outs.

Me: Yes, you do (figuring I'll play along)

Nurse: Ok, well I'll have to put an NGT down <underage> GF then.

That is awesome.

 

[tussy]

This is a consult that i had a couple years ago. It was faxed (no phone call at all, not even by a nurse or clerk) "75y.o. admitted to internal medicine with abdominal pain and fever NYD, had incidental finding of pneumoperitoneum on CT 2 weeks ago. We are sending her home and wonder if any surgery can arrange outpatient workup of pneumoperitoneum "

Yes, the patient had perforated diverticulitis that luckily sealed itself off, but still needed a subsequent perc drain and resection. We found the patient with their coat on waiting for their taxi to take them home.

 

[Winged Scapula]

This is a consult that i had a couple years ago. It was faxed (no phone call at all, not even by a nurse or clerk) "75y.o. admitted to internal medicine with abdominal pain and fever NYD, had incidental finding of pneumoperitoneum on CT 2 weeks ago. We are sending her home and wonder if any surgery can arrange outpatient workup of pneumoperitoneum "

Yes, the patient had perforated diverticulitis that luckily sealed itself off, but still needed a subsequent perc drain and resection. We found the patient with their coat on waiting for their taxi to take them home.

😱

YOU WIN!!!!

 

[Apollyon]

God bless radiologists, but always read your own films, boys and girls 😉

That's one of the beauties of community practice - I had a guy who came in complaining of "pain in my belly after I had a nutty bar after dinner" - arms flexed behind his head, stretched out FLAT, but, two things - hyperresonant belly, and WBC 22K. Afebrile, no n/v, and this just happended 1 hour ago.

Stat plain film shows more free air than I've ever seen, even in pts shot and stabbed in the belly with peritoneal violation.

The surgeon comes right in, and the guy is in the OR about 2100, when the first "symptoms" were about 1900. I say "symptoms", because he had a 2 inch duodenal perf with a belly full of pus, days old. The family actually came back down to the ED and thanked me, and they were laughing because the patient still smelled bad after washout and repair and the wound closed - they said, "We've never smelled anything that bad!" - and, all I could think of was, but didn't say, "I have some surgical friends who could tell you some stories about smells..."

"...like a punch in the face!"

 

[Whisker Barrel Cortex]

Totally hijacking the thread....

...but this KILLS me. Seriously. If I need another service's opinion on my patient, I call the other practitioner and give them the relevant background information and the specific question(s) that I'd like their advice on. I expect the same courtesy in return, but for some reason it seems acceptable to some people to have the nurse or medical student call with a vague request and no idea what the pertinent issues are. And the sad thing is that the poor nurse or MS-3 gets the ire of the consultant, when they're just doing what they're told. Residents that put their nurses/med students in this position...👎

Anyway. Back to the topic at hand.
BEEP BEEP (10 AM on a lazy Friday at the VA)
Me: Hi, surgery returning a page
Med resident: Hi, it's medicine. So we've got this guy who came in yesterday with belly pain.
Me: Uh...okay
Med: He hasn't had a bowel movement or passed gas in a week and he says his belly hurts
Me: How's his exam?
Med:He's a little distended, I guess. We got a CT yesterday.
Me: ....and....?
Med: Well, I'm looking at the reading this morning. And it says there's air.
Me: FREE AIR!?
Med: Uh. Yeah, I guess so.
Me: This scan was done WHEN? (heading down the stairs while I'm talking)
Med: Yesterday afternoon, but the read only popped up today. We were wondering if you guys would come see him. The radiology report said, consider stat surgical consult.

This poor guy was blown up like a tire. We put an NG tube down, while en route to the OR, and got back stool. Our lazy friday turned into a stat ex-lap (and since the senior had already gone home for the day, it was my case 😀 !!)Turns out he had an obstructing left colon ca and had blown out his cecum. And the CT in question? The abdominal organs were squashed, there was so much air.

God bless radiologists, but always read your own films, boys and girls 😉

First off, that would be incrediblely poor service from the radiologist and considered "failure to notify regarding an urgent finding," which is considered malpractice. I don't know a single rad that would not directly contact the ordering provider urgently with a finding of free air. Dissappointing to hear that happen (I geuss the fact that its at the VA may be a factor, but even our VA rads would have called).

Secondly, looking at their own CT scans for most non-general surgery folks doesn't do a whole lot. I'd expect less than half of medicine residents would have picked up on the free air when its impressive, much less if its a small amount. Just in my experience (I'm sure a medicine resident is gonna read this and call me a prick for saying that).

 

[danielmd06]

Secondly, looking at their own CT scans for most non-general surgery folks doesn't do a whole lot. I'd expect less than half of medicine residents would have picked up on the free air when its impressive, much less if its a small amount. Just in my experience (I'm sure a medicine resident is gonna read this and call me a prick for saying that).

As a prelim IM intern going into Neurology next year I would have to say that I agree with you.

I happen to personally be interested in Neuroimaging, and take it as a point of pride to work on my game in that area. But my (admittedly limited) experience seems to be that individuals such as myself are the exception...not the rule.

 

[BurnOnMyYeeeow]

Oh my goodness that is horrendous! Any chance you know what happened to the child?

Didn't make it. I rotated back on a to ped surg a couple years ago and the attending said, remember that crazy phone call? he brought it up because he was going to be off that day giving a deposition regarding that case.