It's officialI hate being an intern. I just had the crappiest day ever. The fact that this crap day comes after working for 2.5 weeks without a day off is just a bonus. A little gift from whatever mean-spirited deity is in charge of residents' lives. So I had my month in the clinic which was going well. Some of my patients are total train wrecks with a dozen problems to sort through, but they are really nice. Then towards the end of the month I got to start to taking telephone call. This is the worst part of primary care...trying to diagnose people over the phone.
"Hi, my baby has a fever. Can you call in an antibiotic?"
"Yeah, I've been having back pain for 4 months." Why the hell is this person calling me at midnight for this? "Can you call in some Percocet?" Hell no, I'm not calling in Percocet. "You have to because I've been buying it on the street and I'm hooked. If you don't give me some I'll kill myself."
"My knee hurts." Dear God, it's 2 am. She can't be serious. "It's been hurting for like 20 minutes." ugh...she is serious. Must get out of bed. "I took some Advil 10 minutes ago and it still hurts." No shit, lady. Now go to bed and stop calling me.
I think you can tell that I started to hate my pager and the people at the other end of the phone. So that ended and now I'm working nights in the Pediatric ER. This hasn't been so horrible until tonight. The worst night of my life so far. The night when I decided that this whole doctor thing might have been a horrible mistake. The night when I could do nothing right. Seriously, nothing. The night when every level of the medical hierarchy yelled at me.
So the evening begins with a 16 year old with blood clots in her legs. They were found 2 weeks ago when she was admitted for swelling and pain in her legs. During her work-up they found a genetic predisposition to forming blood clots. Some digging into her family history revealed that her mother and uncle both died from PEs (pulmonary emboli-blood clots that break off and travel to the lungs). So she was sent home on blood thinners. She came in with shortness of breath and chest pain, classic PE symptoms. CT scan of her chest shows a PE. So I call her hematologist, who says this girl needs an IVC filter (a filter in the vein that brings blood from the legs back the heart) to prevent more PEs. She won't admit the girl and tells me to call surgery. So I call surgery...they won't admit her either. Get pediatrics to admit her, they say. So I call pediatrics. This girls needs more blood thinners and the nurses on the floor won't take her. So I call the PICU. They say the floor nurses should handle her. Somewhere in all this "not it" this poor girl got completely lost. I finally got the PICU to admit her and the surgeons to come see her, but it was a battle.
Then a 10 year old with abdominal pain comes in. We're worried it could be an appendicitis, so I call surgery. I ask the secretary to page the surgery resident for me, but she pages the attending. The attending calls me back and proceeds to yell at me for calling him. When I get the resident to come down, she decides to admit the patient. She writes orders for morphine for pain control and leaves. Then the nurse comes asks for orders for pains meds. When I tell her that the surgeons ordered it already she yells at me for not writing more. I still don't understand this one...there are orders for morphine so give it. Apparently she just wanted it in my handwriting, not sure why.
Next up is a 17 year old who is 2 months pregnant. She's bleeding. I page Ob and they don't call me back. I do an exam, order labs, and get an ultrasound. Page Ob again but they don't call me back. Get results back and the girl has had a miscarriage. Page Ob again and-surprise, surprise-they don't call me back. So now I get to tell her that she's had a miscarriage and then can't answer any of her questions because I know next to nothing about Ob.
To finish my evening, I pick up my last chart at 1am. It's a 2 year old with fever and ear pain. Wonderful. I go in and of course mom doesn't speak English. So my 4 words of Spanish and some pantomime are the way to take this history. Now it's time to look in the kid's ears. They are full of impacted ear wax (some free advice: Q-tips are the devil) so I get the fun job of cleaning them out. So I have Mom hold her son while I jab a long plastic stick with a loop at the end into his ear. He wriggles free, kicks me in the stomach, and jerks his head. In the process I scrape his ear canal with the plastic torture device and he starts to bleed. It's amazing how much an ear canal will bleed. Mom then proceeds to yell at me, in Spanish, while I back away to avoid further kicks from her darling little boy.
There were a lot more patients in my evening, and the others were good encounters. But the bad ones always take over. The good news is that I didn't cry in the ED. I made it all the way to my car before I fell apart and then cried the whole 20 miles home. This is one of those time when I kick myself for choosing to spend the hardest year of the life 1000 miles from home. I know I'm a grown-up now, but I still want my Mom after days like this.