Thursday, January 03, 2008
The good news and bad news of Last Call
The good news first: I’m finally done with my “bad” internal medicine month! I wrote a blog entry while I had four days off in sunny
After returning from my respite, I took call. I ended up having to perform six history-and-physical to get four patients because two of them left against medical advice before I could staff them. Actually, only one left AMA after I completed the full H&P. The other left before I even got to them. I had been reading the ER report and copying the history onto my report. I usually do that so the patient knows that I have actually read their file and then I ask for more details if there are any. I went home and parked my Sebring, slept, woke up to head to work and the Sebring was dead. I figured the only battery must have died. So I jumped into the Subaru. No big deal! I had 4 “normal” days and then I had call on the last day of the rotation, which was Jan 1. Thus, I did not get to celebrate New Years.
I got up at my normal time and got ready: went outside to clean off the eight inches of snow from the Subaru. The highway was complete snow covered with about three or four inches of snow. I’d made it before. I just kept it slow, around 25-30 MPH and trucked down the road. There were no other cars around and all of the sudden, my back-end starts swinging around my left! I was in third gear, so I let off the gas and steered into the skid, but it didn’t help. I ended up off of the road in a ton of snow but not quite in the ditch. I tried to back out, but no luck. I could get the car to go forward, but that was getting me deeper into the ditch. What was worse is I forgot to bring a shovel! So, I called 911 and they routed me to the state police who called a wrecker. I tried to dig the car out with my ice scrapper and I actually got pretty far along when the wrecker showed up. After about an hour or so, I was back on the road. Once I got off of M-14 and onto I-96, the roadway had been better cleared. At least I could see some pavement. I had warned my senior that there was a chance of something like this happening and that I may be late.
Rounds went pretty well, all things considered. We had three patients and my senior took care of seeing two of them. I had just enough time to deal with the last one, the most complicated one, just before our attending arrived. This is a patient (PT) that had a COPD exacerbation because PT kept smoking while PT was recovering from the last exacerbation. PT had to be intubated and required mechanical ventilation so long that we had to place a tracheostomy and a feeding tube (Trach-and-PEG). PT had been in the ICU for half of the month and had been finally sent to the step-down floor. I noticed that the night staff had interpreted PT stating that someone was trying to hurt PT. (Since PT still had a trach, PT can only mouth words and I’m not good a lip reading.) We discussed it during rounds and believed there were at least three reasons for PT to be delusional: ICU-psychosis, steroid induced psychosis and/or benzodiazepine withdrawal. So we start treating for the last two.
I started doing my new admissions around 2p, which was really nice. I cap at five admissions and it’s nice to get them early. I made it through about 3 admissions before I was called back to PT’s room at around 11p. PT’s family was threatening violence if we did not release PT and allow them to take PT to a different hospital. I went to the room and PT’s son told me that one of the ancillary staff was hurting PT and that this person had done so during the last admission and that the family was actually in possession of an apology note from this person. The son seemed good at reading PT’s lips but he seemed to lead the conversation a bit. I listened to the son and took a little time and told him what we thought had been going on but that I understood his concerns. I told him that I would talk to my supervisor and we’ll see if PT is safe to be transferred. I explained the situation to my senior and he contacted the night attending. Ultimately (after about two hours), it was decided that it was not safe to transfer PT but we compromised by allowing the son to spend then night and readdress the issue in the morning.
It ended up taking much of the night to complete my admissions and deal with all of my cross-cover: new-onset ascending cholangitis (not good), just discovered possible aortic pseudo-aneurysm (bad), and a Munchausen’s-by-proxy patient (worse). Well, those were the cross-covers that stand out in my mind.
Post-call, I dragged my butt home and slept for about five hours. I did get 90 minutes during my LAST CALL this year! I drove the Subaru to Wal-Mart to pick up a new battery for the Sebring. I noticed the smell of gas while I was driving there, but I thought it was the car in front of me and I really didn’t smell it later.
This morning I got up and started heading to work. I stopped at the gas station to put some air in my tire and I discovered that the gas was leaking from my car! I figured I’d drive to the Subaru shop but I got lost on the way and when I called, no one answered so I figured they were closed. I decided to just change the battery in the Sebring, but now it was covered in a foot of snow and it was parked next to a little island. Which is bad because some @ss decided to put the battery in the fender well in front of the driver’s side front wheel. First I had to shovel the snow out of the way and gather all the tools. I tried sitting on a sled to keep my butt dry, but that did not work. And, I ended up having to take the wheel off to get to the battery. It took me almost three hours! My butt was frozen and I’m sure I almost got frostbite on my hands. After all it was 1F. Not 1C, 1F! That’s 31 degrees below freezing! It was so cold that my tools were freezing to my rubber-glove covered hand! Got in the car to start it up….nothing. D@MN IT! I ended up have to have the car towed my mechanic who figured out it was the started that died. Unfortunately, the starter is located in the rear of the engine and you have to remove one of the motor mounts to replace it, so it’ll cost about $500.
I finally got hold of the Subaru dealership who informed me that almost all 2002 WRX have a fuel return leak when the temperature drops below 14F. It’s not a dangerous leak because it’s just fumes and not actual liquid gas and that it will stop when either the engine warms up or the outside temp warms up. But, since I have the GOLD extended warranty, the repair is covered. But, they have to order the part. I spent some time surfing the WRX news groups and found out that it is a very common problem with 2002 and 2003’s. It would have been another $500 repair otherwise.
