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Wednesday, August 20, 2008

Call-Bloggin' Again

Spare moment on call again, because of my own peculiar meteorology.

See, medicine has strange weather-based terms to describe a doctor's tendency to attract or not attract patients. Some people are black clouds. Black clouds are inundated with new admissions, nursing pages, and patients' problems the moment they step on the hospital grounds, and usually have to fling their pagers away at the end of the shift, lest they be roped into staying half a day more. White clouds, in contrast, get a ton of sleep and are bored as hell because their patients are the healthiest people God ever set on the earth.

I'm a different sort of guy. I get no more and no less patients than a normal person... they're just never where they're rumored to be. If I'm told that my patient is in the post-op care unit, that means they've actually gone up to the floor. If someone says they're on their way to the hospital, then quite the opposite is likely to be true. Seems like I spend the greater part of the day hunting down my patients in improbable locales. Once, we were taking a kid from the OR back to the NICU, and I volunteered - eager-beaverly - to go ahead and secure an elevator. In the thirty seconds it took for me to get to the elevator and exercise clinical responsibility (read: kick people out of the elevator) my patient desaturated and went back to the OR. Naturally it felt totally awesome to kick some family out of the elevator and then stand there for five minutes waiting for a gurney that would never arrive, enduring their confused stares. Even on very small floors, my patients move about willy-nilly. I'm not a black cloud, or a white cloud, I'm.. what? A patch of fog?

My patient earlier tonight left from one hospital that's about 6 minutes away, and took two hours to materialize. God alone knows where he was.

Anyway, here on my pediatrics AI it's been pretty enjoyable when it isn't musical chairs. Highlights include:

1. The heavy metal kid. Met him one afternoon as I did his admission. He's sittin' there in bed kind of glum - but he's got a Metallica belt buckle and an Ozzy Osbourne shirt on. And not just any Metallica belt buckle, but one in the shape of the "ninja star" on the Load and Reload albums. So I ask him if he liked St. Anger. "No, it sucked." And what bands does he listen to? "Just hardcore stuff, probably you haven't heard of them." I say try me, and he rattles off a couple band names including the awesome Job for Cowboy. When I mention seeing Between the Buried and Me recently in Lemoyne, he perks up immediately and asks me if I knew about this show coming up soon at a local joint. Surprise, surprise: baby-faced soft-spoken young doctors listen to heavy metal, too. Ran into him again today as he and his mom were dropping off some baked goods for the nurses. Turns out he went to that show (at which every band was "insane") and is going to several dozen more in the next few months. Knock 'em dead, kid.

2. The cutest girl on the face of the planet. Save your polaroids of doe-eyed neices, your first-steps DVD's, and your mouths-of-the-babes anecdotes, I've totally got them beat. I walk into this girl's room just to check up on her and she has the bed cranked up about four feet off the floor. The child life therapist is in there with her, and as I come up to say hi, my patient says "You can't get to me because I'm a princess. We're both princesses." Her majesty then informs me that I must pay her one thousand dollars, also due to her status as young royalty. Being quite magnanimous for such a young age, my patient the princess delivers the same proclamation to anyone else who enters the room, being another medical student and two nurses. She looks up from her adorable-girl video game and counts aloud with satisfaction, "One, two, three, four thousand dollars. That's enough for one hundred ponies."

3. Nerf wars. There was this little guy (gone home now) who got into the nurses' stash of Nerf weapons and would sneak around the floor assassinating whomsoever he pleased. Nurses, attendings, other patients and yes, even yours truly fell to his guerrilla tactics. I was shot repeatedly in the leg with a pump-action ball-launcher one day while filling out a discharge sheet, and he even gave a quick lesson in the root cause of his tactical dominance. "You never see me," he said with some glee, "because I always come from this side." Later I found a Nerf pistol and launched a sneak attack of my own, provoking a ferocious firefight in the hall. But that was nothing compared to when he repeatedly took down one of the nurses, a hard-bitten girl who dug up a battery-operated Nerf-dart gatling gun and straight up emptied the magazine on him.

4. MRSA-Ball. There's an entity known as MRSA* which stands for methicillin-resistant Staph aureus. By now, you've heard something about it but the bottom line is it's a particularly mean kind of staph that's also a good bit harder to kill. For most people, MRSA doesn't present a daily health risk because they can fight it off or take some Bactrim, but it can do a number on certain hospital patients. So to prevent the spread of MRSA through the hospital, every patient is swabbed to see if they have it and if they do, they're placed on contact isolation. Which means that nurses, doctors, and med students have to wear a gown and gloves when examining the patient. Whether that's effective is somewhat debatable.

But what certainly isn't effective in preventing the spread of MRSA is confining your MRSA-colonized seven year old patient to her room but giving her a giant ball with which to play catch with the nurses and anyone else who she can sucker. Namely, me. I gamely played MRSA-ball with her for a while, but it quickly got out of hand when she decided it would be fun to try and make me miss. Which means, throw the ball down the hallway to her left and right. She tagged my resident in the back of the head, nearly knocked over a cart, and sent nurses scattering before her staph-coated virulent projectile. After a while it was lunch time so I had to get going. I turn to my attending and say "I'm just going to wash my hands." And she says, "YEAH."

*pronounced "mersa," "emm arr ess eh," "Dear-God-don't-touch-anything" or "everybody's-got-it-in-their-nasal-mucosa-already" depending on whom you talk to.

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