The On-Call Diaries / Blog

[Anasazi23]

And there he goes, with the dancing pe..., errrr bananas

CONGRATS SAZI!!!!!!!!!!!!!!!!!! How many more calls do you have?

One more this week after today's call.



Then I'm a third year, and still take call, but have a bright-eyed, bushy-tailed PGY-1 who I basically supervise.

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[Anasazi23]

I am coming up on the delightful end of weekend/holiday call too--only a couple more left.

The downside is--b/c I'm pregnant & want to get ALL call over with before the 2nd tri ends--is that I'll be on q3/q4 weeknight call for the next 12 weeks. Lucky girl!

Got paged to ER at 3:48 am this morning. To re-admit a pt the unit had d/c'd at 12:30--he asked for a TAR (Tx Auth Request, for Medi-cal pts, for non-formulary meds... how is Prozac non-formulary?) for his Prozac before d/c, they said, "uh, you probably won't need it," he spent 6 hrs trying to get it filled w/o success, then presented to ED with the tiniest "hesitation marks" on his wrist (I've had worse shaving injuries...). Yeah, I wasn't too happy with my fellow resident for booting this guy w/o the TAR--I coulda slept all night otherwise!

Dissing the psych meds usually results in more work for someone else later. Oh well...

Suicide attempt in the ER....gotta go.

 

[sdn1977]

I am coming up on the delightful end of weekend/holiday call too--only a couple more left.

The downside is--b/c I'm pregnant & want to get ALL call over with before the 2nd tri ends--is that I'll be on q3/q4 weeknight call for the next 12 weeks. Lucky girl!

Got paged to ER at 3:48 am this morning. To re-admit a pt the unit had d/c'd at 12:30--he asked for a TAR (Tx Auth Request, for Medi-cal pts, for non-formulary meds... how is Prozac non-formulary?) for his Prozac before d/c, they said, "uh, you probably won't need it," he spent 6 hrs trying to get it filled w/o success, then presented to ED with the tiniest "hesitation marks" on his wrist (I've had worse shaving injuries...). Yeah, I wasn't too happy with my fellow resident for booting this guy w/o the TAR--I coulda slept all night otherwise!

This is why you gotta make of friend of a pharmacist.....no medical justification is required to obtain a TAR within 10 days of discharge from an acute hospital stay - all drugs are covered for the first 10 days. After 10 days, to continue tx, you need the ICD-9 code & drugs tried & failed to obtain payment for non formulary. Fluoxetine is covered on straight MediCal, but may not be covered if your pt is on a special county administered plan - our county (Santa Clara) actually prefers paroxetine...this is CA info only.

But...that didn't help with your night, but it may help with future nights

 

[Anasazi23]

Right...so there's a thread about when to "put your foot down" on malingerers. Once again, Saturday night at 3am brings in NYC's finest. Including a patient who decides to masturbate in his ER room while waiting for me to see him.

Besides being pissed off at the fact that this guy shows up at 3am so that "he didn't have a long wait," he lies about the fact that he's not taking drugs (utox +: cocaine, opiates, methadone), he states that he's going to drive off the GWB. Hard to do this when you don't own a car.

"But this might be the time I decide to turn it all around...you have to admit me because I'm suicidal. I have to go to long-term rehab again."

Good. Bye.

 

[pingouin]

But you're DONE! Come on, you know you needed a good "last weekend call" story to go out on!

"But this might be the time I decide to turn it all around...you have to admit me because I'm suicidal. I have to go to long-term rehab again."

This reminds me of when I did intakes and a guy (self-pay, of course) came into the ED for his 19th alcohol detox.

"But it took my AA sponsor 26 detoxes before he got sober and stayed that way!", and he started spouting numbers about average number of times someone has to go through treatment.

He was informed that 1) this is not a contest to see who can go in the most before it "takes", and 2) this would be a situation where it would be good to be below average.

 

[Anasazi23]

He was informed that 1) this is not a contest to see who can go in the most before it "takes", and 2) this would be a situation where it would be good to be below average.

I like the way you worded that last part.

Too funny.

 

[pingouin]

I like the way you worded that last part.

Too funny.

aw, thanks

works with domestic violence victims, too. last I heard, average number of times it takes to successfully leave the batterer is 7. we may not get you out on the first try, but let's shoot for being below the average.

 

[Anasazi23]

Whelp, it's my last 2nd year call tonight...

Anyone like to venture a guess as to the delights that will befront the ER this lovely 85 degree day in New York city? It'll be hot and stuffy in the shelters, and the psych ward is niiice and air conditioned.

I think I'll be much better in the 'supervisory' role starting in July.

 

[pingouin]

Whelp, it's my last 2nd year call tonight...

Anyone like to venture a guess as to the delights that will befront the ER this lovely 85 degree day in New York city? It'll be hot and stuffy in the shelters, and the psych ward is niiice and air conditioned.

I think I'll be much better in the 'supervisory' role starting in July.

I'm envisioning 5-point restraints and B-52 cocktails in your immediate future...

 

[OldPsychDoc]

Whelp, it's my last 2nd year call tonight...

Anyone like to venture a guess as to the delights that will befront the ER this lovely 85 degree day in New York city? It'll be hot and stuffy in the shelters, and the psych ward is niiice and air conditioned.

I think I'll be much better in the 'supervisory' role starting in July.

I'm suicidal with a plan!
I'm suicidal with a plan!

 

[pingouin]

I'm suicidal with a plan!
I'm suicidal with a plan!

But I won't tell you what it is!

 

[Anasazi23]

I like when they come in and literally announce, "I'm a danger to myself and others."

 

[pingouin]

Samsonitis (noun)- a disorder characterized by a patient arriving at the ED or psych intake office with a packed suitcase in tow without being a direct admit.

 

[Anasazi23]

Samsonitis (noun)- a disorder characterized by a patient arriving at the ED or psych intake office with a packed suitcase in tow without being a direct admit.

This is also a well-known sign. i.e. sign versus symptom.

It is withing bounds, when giving a presentation to a psychiatric attending, to report that you note a positive (+) Samsonite sign.

 

[Psyclops]

Me: So, what brings you in today.
Pt: I can't be safe by myself.
Me: What makes you feel that way?
Pt: I tried to commit suicide.
(at this point it is important to not that there are no outward signs of distress or injury, pt is oriented x3)
Me: What did you do?
Pt: I took 2 aspirin.

 

[pingouin]

Me: So, what brings you in today.
Pt: I can't be safe by myself.
Me: What makes you feel that way?
Pt: I tried to commit suicide.
(at this point it is important to not that there are no outward signs of distress or injury, pt is oriented x3)
Me: What did you do?
Pt: I took 2 aspirin.

True story from a friend- she was the ER social worker, and went in to speak with the patient before the psych resident got there.

SW: So I hear that you overdosed. Is there anyone who you need me to call?
Pt: OVERDOSED? Lady, I'm still alive. That wasn't an overdose, that was an UNDERdose!

 

[Anasazi23]

----------2nd year call----------​

fin .​

 

[Solideliquid]

----------2nd year call----------​

fin .​

Congrats! What was your last case?

 

[TheWowEffect]

Here is another one-

Pt- I am having thoughts of killing myself.
Me- Tell me more...
Pt- I tried to do it.
Me-What did you do?
Pt- I walked across the road to get hit by the traffic.
Me- ???
Pt- The traffic was too slow.....

 

[Anasazi23]

Congrats! What was your last case?

A homeless woman at 4:00 am with a positive samsonite sign (though it was more like Hefty bag sign), that claimed that she needed to be admitted because she was suicidal. While the interview was difficult due to her constantly falling asleep (funny how someone in all that psychic distress can still manage to sleep so well), I noticed she had on a Columbia scrub top, and a Bellevue bracelet. The bracelet had yesterday's date. She "couldn't remember how it got there."

Being in a particularly generous mood, despite the 4am consult, I gave her a tunafish sandwich and a milk, which she was happy to receive.

 

[fiatslug]

Last weekend call of 3rd year. Quick work in the morning made cross cover relatively painless. Get a call from the ED about a guy in 4 point restraints, s/p Haldol 5mg & Ativan 2mg, BAL=203, Utox pos for Cocaine, Methamphetamine, Marijuana--another of life's winners. The guy assaulted a security guard earlier. I go in and the bed's in Trendelenberg, 4 point restraints and something new--some kind of anti-spitting beekeeper's hood, courtesy of the police. Terrible historian, gamey and manipulative, but seems purely antisocial/substance induced, no evidence of organic psych sx. He makes several offers to have sex with me, marry me, etc. Would be a terrible psych admit, in 4 points until 8am, when they would d/c his a$$. Our ED is not set up to let people like this "metabolize to freedom," as they say at the local PES (where guys like this end up 95% of the time instead of in our ED... it's good NOT to be PES!). I call my attending, call the police...

dispo=jail.

I love it when a plan comes together!

On a sad note, though weekend call is over, now begins 3 months of q3/q4 call to get all my 3rd year call done by the time the 2nd trimester is over. Be gentle with me, weeknight crazies!

 

[Anasazi23]

Last weekend call of 3rd year. Quick work in the morning made cross cover relatively painless. Get a call from the ED about a guy in 4 point restraints, s/p Haldol 5mg & Ativan 2mg, BAL=203, Utox pos for Cocaine, Methamphetamine, Marijuana--another of life's winners. The guy assaulted a security guard earlier. I go in and the bed's in Trendelenberg, 4 point restraints and something new--some kind of anti-spitting beekeeper's hood, courtesy of the police. Terrible historian, gamey and manipulative, but seems purely antisocial/substance induced, no evidence of organic psych sx. He makes several offers to have sex with me, marry me, etc. Would be a terrible psych admit, in 4 points until 8am, when they would d/c his a$$. Our ED is not set up to let people like this "metabolize to freedom," as they say at the local PES (where guys like this end up 95% of the time instead of in our ED... it's good NOT to be PES!). I call my attending, call the police...

dispo=jail.

I love it when a plan comes together!

On a sad note, though weekend call is over, now begins 3 months of q3/q4 call to get all my 3rd year call done by the time the 2nd trimester is over. Be gentle with me, weeknight crazies!

I consistently can't understand why police and ambulance drivers insist on bringing out and out criminals to the ER for 'psych evals,' when they are clearly just that - criminals. If you assault someone, you go to jail. If you take drugs and assault someone, you go to jail. At some arbitrary point, people somehow decide, based on no apparent algorithim, to send people to the ER and call the psychiatrist, who confirms that the person is a criminal.

I know about psychosis, paranoia, active delusions, paranoid remission, etc...I'm just saying. It's frustraing as hell.

 

[fiatslug]

I consistently can't understand why police and ambulance drivers insist on bringing out and out criminals to the ER for 'psych evals,' when they are clearly just that - criminals. If you assault someone, you go to jail. If you take drugs and assault someone, you go to jail. At some arbitrary point, people somehow decide, based on no apparent algorithim, to send people to the ER and call the psychiatrist, who confirms that the person is a criminal.

I know about psychosis, paranoia, active delusions, paranoid remission, etc...I'm just saying. It's frustraing as hell.

I KNOW! Somehow the "assault=DTO" thing gets kicked in. (Which, of course, is true and yet totally not psychiatric in these cases). The only good part is how easy & painless it was to have the cops pick him up--SFPD, I love you.

00:30. Awaiting someone from med records to bring over a stack of downtime order forms--the admissions computers have been down for hrs, and I can't admit my little borderline faux suicide attempt! Handwritten orders... ugh. So primitive. I don't know how people put up with them--I did that for a month at SFGH, and when I got the 15th 3 a.m. call to come up and change an order for tylenol to "per rectum" at the bedside for another half-dead neuro pt (the entire neuro service there seems to have a collective GCS of 4.3), I was a danger to others. And to self!

 

[fiatslug]

so I'm posting at 00:40 PST and SDN says it's 07:38. Is SDN on Greenwich Mean Time? Where are my downtime forms!

 

[Anasazi23]

Wanna hear something really sad?

We have hand-written orders, AND downtime forms....don't ask.

 

[Anasazi23]

Happy Last Week of the Medical Academic Calendar, Everyone ! ​

 

[fiatslug]

Wanna hear something really sad?

We have hand-written orders, AND downtime forms....don't ask.

oh my goodness... that's not right!

And... 3...2...1...

MY LAST WEEKEND CALL IS OVER!!

(where can I get me some dancin' bananas?)

(but I have a holiday call next week, which is essentially just like a weekend... ugh...does it ever truly end???)

 

[fiatslug]

The usual bonus of holiday call is almost preternatural quiet from the ED. Not today (today being the 3rd, a quasi/dept holiday). After admitting a chronic EtOHic for detox (not too exciting) and a very paranoid 28 yo F w/strong FH for schizophrenia and suicide and with some poignant insight into the bizarre nature of her paranoia (much more interesting), I got a call about a woman presenting with chief complaint of "I have DID, and one of my parts wants to kill the other part."

The ED doc was convinced it was characterological, and over the phone, so was I, initially. I brushed up on DID in the DSM. Wow--her presentation was utterly convincing. High functioning, working full time, history of horrendous physical/sexual/emotional abuse as a child. 6 alters total, I "met" 3 of them, including the one who wants "to kill us all." Also talked with her therapist and psychiatrist--he said in 30 years, she's the only pt with DID he's ever seen.

I get so burnt out on the usual chronics and malingerers in the ED--tonight was pretty incredible, in terms of real psychiatric pathology. Schizophrenics with preserved insight always break my heart a little bit. And DID--how often do you see that? Up until tonight I probably thought it was just a crap dx, characterologic issues writ large. And thinking about it, I do wonder if it should be coded on Axis II (though the dissociative tendencies are heritable, per the DSM), given that it arises in the setting of really terrible childhood crap. She also has dx of PTSD, and has been told she has "borderline traits" (one of the alters is a cutter). I was struck by how normal and likeable the primary personality was.

0120... dare I go to bed? Was I foolish to attempt my 3rd trip thru bridge & tunnel home on call (we all take call from home, but most everyone else lives in the city)? Time will tell...

 

[fiatslug]

0350. I give up. I surrender to my black cloud. 2 in the ER (one now in 4 point restraints after the ol' 5250 IM), one malingering dump intake from an outside facility (homeless, shows up in an ED with bags packed and very faux SI, nevertheless placed on a hold by someone else and so becomes my problem), and a hooker with an ankle lac (courtesy of her john) who wants to see psych and a patient ombudsman at 4 in the morning (thankfully, she will be seeing SFPD shortly instead).

Bring it, do you hear me, black cloud? Is this the best you can do?

 

[Anasazi23]

Bring it, do you hear me, black cloud? Is this the best you can do?

There's always one in each residency class year. Thankfully, I seemed to have escaped it. It's very clear who has it in each year though.

Did you try voodoo or spiritually cleansing your beeper?

 

[fiatslug]

Did you try voodoo or spiritually cleansing your beeper?

Would a toilet flushing spiritually cleanse my beeper?

 

[MBK2003]

Would a toilet flushing spiritually cleanse my beeper?

For me it was not the beeper, since I was in the psych ER on nightfloat, but apparently my own inner "magnetism" which drew various and sundry malingerers, sociopaths, and acutely psychotic or manic patients to our emergency room. Since I no longer have to do NF as a PGY-4, I am no longer considering voodoo or countermagnets, but this special "talent" still very much impacts my moonlighting shifts.

MBK2003

 

[fiatslug]

So what does "on call" mean for everybody? At my program (4 residents/yr), we are an on-call N=1, staffing cross-cover on the inpt psych unit, intakes on same from outside facilities, anything in the ER, and any urgent consult cases overnight (which generally equate to "you've got to come over and put this delirious combative patient on a psych hold!" along with the occasional urgent liver Tx eval). It seems like bigger programs have more than one person on call, and/or night float... must be nice! (not being night float, but having night float...)

 

[Anasazi23]

So what does "on call" mean for everybody? At my program (4 residents/yr), we are an on-call N=1, staffing cross-cover on the inpt psych unit, intakes on same from outside facilities, anything in the ER, and any urgent consult cases overnight (which generally equate to "you've got to come over and put this delirious combative patient on a psych hold!" along with the occasional urgent liver Tx eval). It seems like bigger programs have more than one person on call, and/or night float... must be nice! (not being night float, but having night float...)

Pretty much the same for me. Though it depends on what year you are.

PGY-1: On call with a supervising 3rd year
PGY-2: On call commando (alone)
PGY-3: Supervising the first year.
PGY-4: NO CALL

The first year is obviously tough, as the third year doesn't do that much actual work...mostly supervises the PGY-1 on consults, ER cases, unit problems, etc.

PGY-2 is the toughest. Covering the unit alone, transfers from other hospitals, late discharges, ER cases, medical floor cases, including high-yield consult floor such as hospice, ICU, CCU, dialysis, and of course.....detox.

I'm in PGY-3 now...so life is much better. Although, I still can get up in the middle of the night to see a first break in the ER, combative guy in the ER or detox, hyperactive delirium on the floors, or agitation/violence, or endless medical complaints in the psych floor.

When I'm an attending, they'll have to pay me a lot of money to do this voluntarily. It'll be a huge deciding factor on where I work.

I'll work as hard as you want during the day, but I friggin' hate the overnight thing.

I guess the upside to call, particularly overnight call, is the learning opportunities. You see many more patients than those who don't take such call, and tend to see more raw, unadultered psychopathology and are forced to make good treatment decisions without full mental capacity. It sort of makes it remote for you as a resident...which will make you a better attending.

A neuropsychiatrist that I greatly respected told me once before I started residency, "Don't be afraid of call. That's where you learn the most."

 

[Doc Samson]

A neuropsychiatrist that I greatly respected told me once before I started residency, "Don't be afraid of call. That's where you learn the most."

Amen brother.

 

[fiatslug]

I guess the upside to call, particularly overnight call, is the learning opportunities. You see many more patients than those who don't take such call, and tend to see more raw, unadultered psychopathology and are forced to make good treatment decisions without full mental capacity. It sort of makes it remote for you as a resident...which will make you a better attending.

A neuropsychiatrist that I greatly respected told me once before I started residency, "Don't be afraid of call. That's where you learn the most."

I totally agree about call. It sucks, you wouldn't want to do it for the rest of your life, it gives me stinky post-call feet from running around all night, but it is a fantastic learning experience. Call gives you balls, if you know what I mean (and I'm a pregnant girl!).

I don't want to hog all this great learning, however , and look forward to passing it on to next year's PGY-1 to 3's. The major call bitterness comes from the malingerers and anything that comes in after 3 am--hey, did I just repeat myself?

 

[MBK2003]

So what does "on call" mean for everybody? At my program (4 residents/yr), we are an on-call N=1, staffing cross-cover on the inpt psych unit, intakes on same from outside facilities, anything in the ER, and any urgent consult cases overnight (which generally equate to "you've got to come over and put this delirious combative patient on a psych hold!" along with the occasional urgent liver Tx eval). It seems like bigger programs have more than one person on call, and/or night float... must be nice! (not being night float, but having night float...)

My program call is broken up
PGY-1 - no call on psych electives, q4 on the 6 months of medicine
PGY-2 - floor call covering admissions and questions on the 4 inpatient units
PGY-3 - Psych ER nightfloat and emergency psych consults in the general hospital
PGY-4 - Buddy call for PGY-3's July & August, then C/L call on weekends for the 4 months of C/L.

Now being a PGY-4, my life is pretty sweet, so I'm moonlighting like a "lunatic" to masochistically torture myself into feeling like when I was a PGY-3.

MBK2003

 

[Poety]

My program call is broken up
PGY-1 - no call on psych electives, q4 on the 6 months of medicine
PGY-2 - floor call covering admissions and questions on the 4 inpatient units
PGY-3 - Psych ER nightfloat and emergency psych consults in the general hospital
PGY-4 - Buddy call for PGY-3's July & August, then C/L call on weekends for the 4 months of C/L.

Now being a PGY-4, my life is pretty sweet, so I'm moonlighting like a "lunatic" to masochistically torture myself into feeling like when I was a PGY-3.

MBK2003

but isnt the money sweet!

i cant wait to moonlight next year

 

[alina_s]

On day call yesterday, I was paged by a SW from an outside hospital who wanted me to accept a patient as a transfer. Apparently, her peer who had been on duty Friday had planned the transfer but "medical issues" arose delaying the transfer. On further questioning, the patient was so demented that she didn't eat anymore and the team had decided on a PEG tube. Apparently, 24 hours was enough time to resolve her malnutrition (and any recovery from the minor surgery) but she was also "depressed" and really needed to be on our ward. The SW was calling from home and had never laid eyes on the patient or her record. Arrgh!

 

[Anasazi23]

On day call yesterday, I was paged by a SW from an outside hospital who wanted me to accept a patient as a transfer. Apparently, her peer who had been on duty Friday had planned the transfer but "medical issues" arose delaying the transfer. On further questioning, the patient was so demented that she didn't eat anymore and the team had decided on a PEG tube. Apparently, 24 hours was enough time to resolve her malnutrition (and any recovery from the minor surgery) but she was also "depressed" and really needed to be on our ward. The SW was calling from home and had never laid eyes on the patient or her record. Arrgh!

I can't stand stuff like that, and it happens in our hospital all the time. There's an unbelievable amount of dumping going on with 'psych' patients, and it's infuriating.

I'll never forget the transfer I had to admit which showed up in essentially an ICU (anti-decubiti) bed, with a trach, 100% O2, PEG, and two medium-bore IVs in both arms, running ringers and other stuff.

The patient was barely conscious.

I asked the nurse.."what the hell is she admitted for?" The nurse replied that it was a transfer because she was "pulling on her tubes and appeared depressed."

Holy friggin s*%^. Why can't these cases be managed by the c/l team in the other hospital for God's sake...it's criminal. The day wasn't out before I found her suspicious for sepsis, and wound up transferring her to our own ICU.

 

[fiatslug]

I can't stand stuff like that, and it happens in our hospital all the time. There's an unbelievable amount of dumping going on with 'psych' patients, and it's infuriating.

I'll never forget the transfer I had to admit which showed up in essentially an ICU (anti-decubiti) bed, with a trach, 100% O2, PEG, and two medium-bore IVs in both arms, running ringers and other stuff.

The patient was barely conscious.

I asked the nurse.."what the hell is she admitted for?" The nurse replied that it was a transfer because she was "pulling on her tubes and appeared depressed."

Holy friggin s*%^. Why can't these cases be managed by the c/l team in the other hospital for God's sake...it's criminal. The day wasn't out before I found her suspicious for sepsis, and wound up transferring her to our own ICU.

Drives me nuts the way the med/surg folks play hot potato with any patient with a psych hx. Once we had an ER doc sign off on a patient as "medically clear" with a fever, a white count, and a pus-oozing post-op shoulder incision (though our admitting resident kept asking, are you SURE this guy is clear?). Later that night, while I'm on call, he spikes to 39.1 on the unit, WBC>18K, and his wound is essentially opening in front of us. We called the ER back, the new ED attending essentially said "wtf?" when she got a look at this guy, and they ended up transferring him to the OR of the hospital where he got the shoulder surgery done in the first place! It's all about Dispo, alas.

 

[Hurricane]

After a month in the pscyh ER, I am hating the "nursing home dump." We had a poor guy sit in our ER for almost 48 hours waiting for placement because his nursing home dumped him on our doorstep and refused to take him back because of his "dangerous behavior." The offending action - swatting another patient with a pillow.

 

[Anasazi23]

It brings up a philosophical question that I constantly think (ruminate) about...at what point did the hospital become the all-inclusive "solve any life problem" office of the universe?

Kicked out of your apartment? I'll go to the hospital.

You're old and you hit another person with a pillow? I'll go to the hospital.

They cut off my Medicaid? I'll go to the hospital.

I was caught breaking and entering into someone's apartment then screamed loud when I was caught by the police? I'll go to the hospital.

I don't like my roomate at the SRO? I'll go to the hospital.

The shelter is hot and sweaty and smells bad? I'll go to the hospital.

I can't stand the food that my crazy mother makes at home? I'll go to the hospital.

I'm homeless and the bottom of my shoes have rotted out? I'll go to the hospital.

I'm literally too fat to get on a chair and change the bulb in my livingroom ceiling light, therefore I'm sitting in the dark all day and night? This is exacerbated by the fact that I'm a slob and haven't taken out the garbage in 3 months and can't take a shower because the bathroom tiles have rotted off the wall and fell into the tub, which I'm henceforth also too fat and lazy to clean up? I'll go to the hospital.

I ran out of medication because I abused it and don't feel like waiting 24 more hours for my appointment? I'll go to the hospital.

My father kicked me out of our Houston home because I'm so annoying and he bought me a one-way ticket to New York City to fend for myself, but I have no friends here and I don't like sleeping in the park, but somehow managed to save up enough pan-handling money to buy crack and heroin? I'll go to the hospital.

I have a personality disorder and can't cope with the fact that my equally crazy boyfriend is leaving to go "on vacation" for 3 weeks, and can't stand the thought of being alone in our apartment for that period of time? I'll go to the hospital.

I've been living in NYC for the last number of months and have decided that I shoudl return to my homeland - the great state of Alabama, but have no money for a bus or plane ticket and think that the hospital will provide me with one because "some guys said I could do that and that it worked for them?" I'll go to the hospital.

The Red Cross shelter is closing becuase they sold the building, and I'm 85 years old and I've been living there for the last 40 years and they're having trouble placing me. I'll go to the hospital.

I'm a drunkard that's been in detox 35 times in the last 4 years, and was yet again found lying literally in a gutter on St. Mark's place minding my own lack of business when the ambulance showed up and pulled over so the guys could get a slice of pizza on their break. I'll go to the hospital.

I'm a regular old person who's been living independently for my entire 76 year-old life but find that it's increasingly difficult to reach the Chef-boy-r-dee ravioli cans in the upper part of the cabinet and require either homecare or perhaps a home nursing service. I'll go to the hospital.


The hospital should be a place where you go, like a store, to get something. In this case, healthcare, and then when the transaction is done, you leave...on your own will...not in an ambulette because you don't want to drop the 2 bucks for the subway ride back to the Bronx. No apartment placement, no bull&^%$. Just get the commodity, and leave.

You don't see Wal-Mart placing people who demand SROs in the city, or providing $1000 ambulance rides back to their apartment, where the person literally demands that they dump her into her bed directly from the stretcher because "it's too hot out to walk."

 

[Dr. H]

Hi Anasazi23,
I just want to tell you that I find your blog really interesting. I myself am in the exploration stage and appreciate having a resource such as your experience available. Thanks for taking the time.
H

 

[Anasazi23]

Hi Anasazi23,
I just want to tell you that I find your blog really interesting. I myself am in the exploration stage and appreciate having a resource such as your experience available. Thanks for taking the time.
H

It's [usually] my pleasure.

Welcome.

 

[Anasazi23]

So I went to a Lilly drug dinner last night on the "Neurobiology of depression" taught by a Johns Hopkins Psychiatrist. It was at a fancy restaurant that was reserved for the dinner only.

It was horrible. The chicken was so-so, the talk had virtually no clinical relevence, and here's the kicker...When I asked them to refill my wine glass, the waiter told me "Sorry, only one glass per participant tonight."

I was outraged. They said if I wanted another glass that I'd have to pay for it. Pay for it ?!

Then I aspirated some powder stuff on the top of my tiramisu and coughed for like 3 minutes straight. I now have a lung granuloma of tiramisu powder next to the hamburger helper granuloma I got in college when I aspirated a marble-sized chunk of cheesy macaroni variety.

The woman sitting next to me was complaining that she no longer made any good money...that her income had dropped 100k this year. She had a great location for a private practice and it seemed puzzling. There seemed to be an odd disconnect between us. Then I asked outright because it just felt weird...."Are you a psychiatrist?" She said, "no." Thank God! She's an IM doc, which makes much more sense. She said, "Oh, no, psychiatrists make way more than me..."

I talked to the Lilly girl, whom I know, about the wine situation. She apologized, stating that she didn't arrange this, and would make it up to us.

Yes, this is a very hedonistic post.

I don't care.

 

[fiatslug]

Then I aspirated some powder stuff on the top of my tiramisu and coughed for like 3 minutes straight. I now have a lung granuloma of tiramisu powder next to the hamburger helper granuloma I got in college when I aspirated a marble-sized chunk of cheesy macaroni variety.

That's the funniest thing I've read all day. You betta hope you don't have a positive TB test one day or you'll have some explaining to do to Occ Health!

 

[fiatslug]

It's HUMP CALL!

(get yr minds out of the gutter... tonight is the halfway point of my PGY-3 maternity 3-month call bolus!)

thank god for the power surge of the 2nd trimester...

 

[fiatslug]

0255. Dang, am I the only psych resident who takes call anymore? Admitting an alcoholic, benzo and heroin addicted psychologist for the second time personally (multiple admits, multiple psych hospitalizations) after his umpteenth suicide attempt, involving the multiple benzos someone inexplicably keeps prescribing for him, though they are always his OD weapon of choice.

Next, off to see "I hear voices/gimme a sandwich" guy who's been to at least 3 ERs tonight. Wish the ED doc would just kick him to the curb, but "since you're here..."

Nine more lifetime residency calls. Full load of outpatients from 8am-1pm. I heart residency, I heart residency...

 

[Anasazi23]

0255. Dang, am I the only psych resident who takes call anymore? Admitting an alcoholic, benzo and heroin addicted psychologist for the second time personally (multiple admits, multiple psych hospitalizations) after his umpteenth suicide attempt, involving the multiple benzos someone inexplicably keeps prescribing for him, though they are always his OD weapon of choice.

I take calls still, but have the first year doing the heavy lifting. I'm there for my 'expertise.'

The beautiful thing for me, being a third year, is that I no longer admit transfers from other hospitals. We get a lot, and it can bog down your night like nothing else. Especially when they show up at midnight from an unnamed 'uptown' hospital. If that isn't bad enough, they lie about their medical clearance about 75% of the time. So, that means I'm evaluating and in some cases, immediately transferring to medicine, things like bowel obstructions, impending DTs, major wound infections, O2 sats of 70 on RA. fulminant conjunctivitis with possible ascending infection, and lots of other wonderful surprises.
Now the first year just gets scared as hell and calls me to evaluate the patient.

Next, off to see "I hear voices/gimme a sandwich" guy who's been to at least 3 ERs tonight. Wish the ED doc would just kick him to the curb, but "since you're here..."

Nine more lifetime residency calls. Full load of outpatients from 8am-1pm. I heart residency, I heart residency...

Ah, yes, the new diagnostic category that I enjoy..."Acute housing crisis"
(Feel free to create modifiers so that we can submit it to the DSM-V Task Force).

There are few things more irritating than a middle of the night curbside consult in the ER "since you're here." I feel for you...private practice is calling my name......Sazi........come with us..........it's better hereeeeee...........no conferences.........better money........better hours..........no obnoxious personalities (except from the patients) that you are forced to deal with every single friggin' day........no hospital administrative bull*&[email protected] ussssssss..........