Clusterf*ck me, baby
I don't generally like to bitch about irksome things at the hospital in this forum because I think if laypeople were exposed to the inner workings of the system, they'd be horrified. However, given the fact that I just survived my first full weekend of being on call, I am too full of righteous indignance and the spirit of complaining not to write this down.
A patient arrives to the hospital with a suspected intestinal bleed. The backdrop is that he was recently in the hospital for unrelated reasons, and needed a feeding tube placed; GI refused to do it because of extensive ulcer disease in his stomach, but surgery placed one anyway, despite the contraindication. So, now this guy is sitting pale and dizzy in the surgery outpatient clinic. They call me, the GI fellow, to evaluate. I come - I say, check all labs, transfuse the patient, get his numbers to look better, and we will take a look in endoscopy tomorrow.
Tomorrow comes, and the gentleman comes down to endoscopy. I'm all gowned up, when I take a peak at the monitor - and note that he's not looking too stable, heartrate too fast, he's sweaty... I look at his labs - the surgeons clearly failed to transfuse him! According to the computer, he has basically lost almost half of his blood volume! We send the guy back to the floor for a transfusion. I write the order myself, and call the resident to tell him that this is what's happening. Later in the afternoon, I call up the floor to check if he's had his blood and we can do the endoscopy - and find out that it's 6 hours later (it's now 4pm on a Friday), and he still hasn't gotten any blood. He's basically sitting around with a hemoglobin barely compatible with life. Ok, you take care of this, and we'll hold off on performing the procedure until tomorrow. I leave.
I'm driving along, and my pager goes off because I'm on call. It's an angry surgical resident. "The patient is pouring out blood. He has to be scoped, tonight!" "We can't scope him tonight, if he's pouring out blooe, he needs blood replaced, and then we'll do it first thing tomorrow." "No need to get snippy with me! My attending wants him scoped!" "Well. Have your attending call my attending then."
I get home and start making dinner. The pager goes off again, pleasing alert #7. It's the surgery attending. "The treatment for a GI bleed is not resuscitation, it's endoscopy," he says, forgetting the fact that endoscopy can kill you if you're not stable. "Is the patient in the ICU if he's so unstable?" "ummm no" "Well, it's after hours, he needs to be in the ICU, There is no other place to do this safely." "I'm calling your attending." "Please do."
Another half an hour goes by, and my own attending calls me. Apparently, as expected, he got a call from the surgeon, who was flipping out on the phone about the exsanguinating patient (who's sitting on the floor "resting comfortably in no acute distress," ie NOT exsanguinating) and my refusal to come in. "Oh yes, we will get him transferred to the ICU, we're all over it. In fact, the nurse manager tells me he's already got a bed, bed 67." My attending says I should go in and assess the patient.
So, I get in the car, and drive all the fucking way back to the hospital and go to assess the patient. By this time, he's had his blood, he's pinked up, perked up, he's watching TV. Vitals signs are rock solid stable. I'm asking the nurse: is he really pouring out blood? Not since I've been here, she says.
I call back my attending and give him the scoop. The patient is absolutely stable, he's on a floor, we should call in a tech tomorrow and perform the procedure under controlled conditions down in the GI lab instead of rushing around and doing this late at night without a tech, without nothing, in a cramped unit room. "Well..." says the attending. "you see, this surgeon is the one who came down and helped us twice this week when we had complications happen down in endoscopy, and normally, I'd get into it with him, but not now, you see. This guy getting scoped tonight, as soon as he goes to the unit." At this point it's 8:30. I'm swearing. And sweating.
Sure, hospital politics, I get it. You rub my back, I rub yours, I'll slice a belly or two open for ya on an emergency basis, if you send in your fellow when my residents fuck up and freak out so she can clean up their shit so no one gets in trouble.
ANYway. The point is, what would be best for this poor patient??
I call the unit: does my patient have a bed? Oh, we're waiting on transfer orders for patient in bed 67, then he can go to a floor, we will clean the room, and then your patient can come.
I call the surgery cross cover: the nurses say, patient so and so in bed 67 needs transfer orders so they can get him out, get my guy in, and get this "urgent" endoscopy under way. Could you please take care of this? yea yea sure sure.
By the by, where are these surgeons, who were blowing up my phone, the primary team who's supposed to be taking care of this patient? Are they facilitating the unit transfer so I can do what they asked, nay, demanded? No. I am.
I hurry up and wait.
Call the unit an hour later: "What's the status?" A nurse says via gritted teeth: "We're doing the best we can, doctor." This is nurse code for "fuck off." It's their speak for "the union says, we cannot start working before 6:57 a.m. when the shift starts at 7 unless the overtime is approved." It's a fancy way of saying, "This is a) not in the protocol, and b) not in my job description. DOCTOR."
I go down to the unit personally. There are empty beds! Why can't my patient get into one of those? We don't have the nursing power. It's against union rules.
It's 10:30 PM. It suddenly dawns on me. At 11 o'clock is shift change. The overtime or whatever, is not "pre approved." The nurses are basically waiting until the night nurses come on to pawn off this case on them, so the latter can deal with the procedure and the former can go home. Is there any chance my patient can get in here? "We're doing the best we can, doctor."
At this point, I'm not swearing anymore, I'm essentially crying. I call back my attending. WTF! He agrees it's ridiculous, and says I can go home - but we should come and scope this guy first thing in the morning. That means 6 am, which means I get my ass up at 5 am after 3 hours of sleep, and prepare to spend a whole Saturday in the hospital.
Still no sign of the worried surgeons who were so concerned about this sick sick patient.
Politics, laziness and the futility of being low on the totem pole!! Is this really effective utilization of resources? Cause I'd rather be sleeping. Or eating. Or fucking. Really.
And the most ironic thing of all, when we finally DO get to scope this patient the next morning, THERE IS NO BLEEDING! He's stopped. On his own. So much for emergencies.
And you know what? That was just a typical Friday night.
/rant.
A patient arrives to the hospital with a suspected intestinal bleed. The backdrop is that he was recently in the hospital for unrelated reasons, and needed a feeding tube placed; GI refused to do it because of extensive ulcer disease in his stomach, but surgery placed one anyway, despite the contraindication. So, now this guy is sitting pale and dizzy in the surgery outpatient clinic. They call me, the GI fellow, to evaluate. I come - I say, check all labs, transfuse the patient, get his numbers to look better, and we will take a look in endoscopy tomorrow.
Tomorrow comes, and the gentleman comes down to endoscopy. I'm all gowned up, when I take a peak at the monitor - and note that he's not looking too stable, heartrate too fast, he's sweaty... I look at his labs - the surgeons clearly failed to transfuse him! According to the computer, he has basically lost almost half of his blood volume! We send the guy back to the floor for a transfusion. I write the order myself, and call the resident to tell him that this is what's happening. Later in the afternoon, I call up the floor to check if he's had his blood and we can do the endoscopy - and find out that it's 6 hours later (it's now 4pm on a Friday), and he still hasn't gotten any blood. He's basically sitting around with a hemoglobin barely compatible with life. Ok, you take care of this, and we'll hold off on performing the procedure until tomorrow. I leave.
I'm driving along, and my pager goes off because I'm on call. It's an angry surgical resident. "The patient is pouring out blood. He has to be scoped, tonight!" "We can't scope him tonight, if he's pouring out blooe, he needs blood replaced, and then we'll do it first thing tomorrow." "No need to get snippy with me! My attending wants him scoped!" "Well. Have your attending call my attending then."
I get home and start making dinner. The pager goes off again, pleasing alert #7. It's the surgery attending. "The treatment for a GI bleed is not resuscitation, it's endoscopy," he says, forgetting the fact that endoscopy can kill you if you're not stable. "Is the patient in the ICU if he's so unstable?" "ummm no" "Well, it's after hours, he needs to be in the ICU, There is no other place to do this safely." "I'm calling your attending." "Please do."
Another half an hour goes by, and my own attending calls me. Apparently, as expected, he got a call from the surgeon, who was flipping out on the phone about the exsanguinating patient (who's sitting on the floor "resting comfortably in no acute distress," ie NOT exsanguinating) and my refusal to come in. "Oh yes, we will get him transferred to the ICU, we're all over it. In fact, the nurse manager tells me he's already got a bed, bed 67." My attending says I should go in and assess the patient.
So, I get in the car, and drive all the fucking way back to the hospital and go to assess the patient. By this time, he's had his blood, he's pinked up, perked up, he's watching TV. Vitals signs are rock solid stable. I'm asking the nurse: is he really pouring out blood? Not since I've been here, she says.
I call back my attending and give him the scoop. The patient is absolutely stable, he's on a floor, we should call in a tech tomorrow and perform the procedure under controlled conditions down in the GI lab instead of rushing around and doing this late at night without a tech, without nothing, in a cramped unit room. "Well..." says the attending. "you see, this surgeon is the one who came down and helped us twice this week when we had complications happen down in endoscopy, and normally, I'd get into it with him, but not now, you see. This guy getting scoped tonight, as soon as he goes to the unit." At this point it's 8:30. I'm swearing. And sweating.
Sure, hospital politics, I get it. You rub my back, I rub yours, I'll slice a belly or two open for ya on an emergency basis, if you send in your fellow when my residents fuck up and freak out so she can clean up their shit so no one gets in trouble.
ANYway. The point is, what would be best for this poor patient??
I call the unit: does my patient have a bed? Oh, we're waiting on transfer orders for patient in bed 67, then he can go to a floor, we will clean the room, and then your patient can come.
I call the surgery cross cover: the nurses say, patient so and so in bed 67 needs transfer orders so they can get him out, get my guy in, and get this "urgent" endoscopy under way. Could you please take care of this? yea yea sure sure.
By the by, where are these surgeons, who were blowing up my phone, the primary team who's supposed to be taking care of this patient? Are they facilitating the unit transfer so I can do what they asked, nay, demanded? No. I am.
I hurry up and wait.
Call the unit an hour later: "What's the status?" A nurse says via gritted teeth: "We're doing the best we can, doctor." This is nurse code for "fuck off." It's their speak for "the union says, we cannot start working before 6:57 a.m. when the shift starts at 7 unless the overtime is approved." It's a fancy way of saying, "This is a) not in the protocol, and b) not in my job description. DOCTOR."
I go down to the unit personally. There are empty beds! Why can't my patient get into one of those? We don't have the nursing power. It's against union rules.
It's 10:30 PM. It suddenly dawns on me. At 11 o'clock is shift change. The overtime or whatever, is not "pre approved." The nurses are basically waiting until the night nurses come on to pawn off this case on them, so the latter can deal with the procedure and the former can go home. Is there any chance my patient can get in here? "We're doing the best we can, doctor."
At this point, I'm not swearing anymore, I'm essentially crying. I call back my attending. WTF! He agrees it's ridiculous, and says I can go home - but we should come and scope this guy first thing in the morning. That means 6 am, which means I get my ass up at 5 am after 3 hours of sleep, and prepare to spend a whole Saturday in the hospital.
Still no sign of the worried surgeons who were so concerned about this sick sick patient.
Politics, laziness and the futility of being low on the totem pole!! Is this really effective utilization of resources? Cause I'd rather be sleeping. Or eating. Or fucking. Really.
And the most ironic thing of all, when we finally DO get to scope this patient the next morning, THERE IS NO BLEEDING! He's stopped. On his own. So much for emergencies.
And you know what? That was just a typical Friday night.
/rant.
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