One and Only

Chapter 7 - Down the Rabbit Hole

To someone who has never experienced it before, the degree of dysfunction that occurs in a small community hospital can be astonishing. And I don't mean small things, like labs being misplaced or orders for physical therapy being ignored, I mean big things like losing power to the entire OB wing of the hospital and finding that someone has died in the waiting room while waiting to be seen.

Thankfully, I was getting close to when I wouldn't have to work any more shifts in this God-forsaken place, but I still had to get through this week of nights, another week in March, and then a few more scattered weekends over the next eight months. Our night shifts started at 7 pm with what was called "sign out," which is where the interns would take turns running through "the list" of patients that they were managing, and the shift ended the next morning at 7am.

During sign out, the day team would give you a brief synopsis about what the patient had been admitted for, what had been accomplished during the day, and what labs or tests still needed to be followed up on. Sometimes there would be a lot to do in terms of monitoring them, but sometimes the patients would just slumber peacefully through the night without needing much intervention on behalf of the mole (the position that I currently occupied). I should rephrase that; no one who has ever had to sleep in a hospital would call it peaceful. Patients were subjected to constant interruptions from doctors, nurses, aides, phlebotomists, therapists, chaplains, cleaners, family and friends. You could tell sometimes when a patient was reaching the end of their rope at the hospital and I would always say to them, "the hospital is where we keep sick people, so if you want to go home to get a good night's sleep, you're going to need to get better!"
Recently, our residency had changed how we organized the night shift so that there was both an intern - who was a first year physician, fresh out of medical school - and a third year resident on duty every weekday night, and then only a third year (but a different one) on "weekend mole."
From the standpoint of the third year, this was a pretty sweet deal because it meant that there were two people who could do all of the things that needed to be done during the night, but it also meant that there was a responsibility on behalf of the third year to make sure that the intern was learning the ropes of the hospital but also thriving and not being terrified to the point of quitting residency. It may sound silly, but this was actually pretty tough: like threading a needle while on the back of a moving motorcycle.

I hadn't worked with many interns in the new first year class, so I didn't know much about the person I would be working with this week other than that his name was Clayton Howard, and that he was from Kentucky. When I arrived at the resident room in time for sign out at 6:50, Clayton was already there, dressed in a pair of light blue scrubs (one of the perks of the mole shift is that scrubs were allowed, whereas those residents working days had to wear "work clothes.")
The day team wasn't quite ready to begin because they had had a late admission at around 5:30, and apparently there were two more people in the ER who were also likely going to need to be admitted, so I was anxious to get sign out underway. At 7:05, the day interns still hadn't even finished updating the list and were nowhere near ready to begin sign out, and we got a page from the ER (yes, actual pagers were still used in the hospital, an anachronism so dated that it was almost cute). I asked the intern who had been carrying the pager to toss it to me so that I could call them back.
"Hey, this is Jen, the night mole, what's up, I was paged?"
"Hey Jen, this is Abby down in the ER, let me grab Dr. Crane, I think he's got two for you."
I waited patiently as she went to go get Dr. Crane, and pulled out an empty piece of paper so that I could take notes. When Dr. Crane got on the phone he greeted me warmly. "Hey Jen, long time no see. You're doing well, I hope?"
"Hey Dr. Crane, I'm here, so how well can I be, right?" I joked, knowing that he would not be put off by my morose sense of humor.
"Well, I've got two nice and easy ones for you to start the night off right. Just kidding, one is nice and easy and one is a complete train wreck. Should be fun."
"Hit me," I said, with my pen poised above the paper.
"The first is a 76 year old female, sweet lady, she's got diabetes, hypertension, depression, anxiety and osteoporosis. She fell and broke her hip; ortho has already seen her, and they're hoping to go to the OR tomorrow morning, but they want the medicine team to manage her diabetes. Biggest problem for her is going to be her A1c, which was 11.7, and pain control, which she has been struggling with here in the ER.
The second one is a little bit more complicated, but basically he's a 35 year old male who was found down at his apartment by a sheriff's deputy who was serving him an eviction notice. He's got a multitude of problems, which will become evident when you see him, but I would say that his biggest issue is acute renal failure and, uh, let's just call it 'failure to thrive,' you'll understand what I mean when you see him. He's going to the ICU, and we've already touched base with Dr. Leung who is ready for you guys to come down and take a look at him. Oh, and Jen, make sure you're wearing scrubs," he said, barely able to conceal the glee in his voice.
"Wear scrubs? What, is he, like, covered in shit or something?" I asked, wondering what could possibly be so bad to warrant that bit of advice.
"Oh, definitely 'or something'" he said, chuckling to himself.
"The day team hasn't even started signout, so I might send the night intern over to get the lay of the land, and then I'll be down in a minute."
"Sounds good," he said casually, "we'll be here." I hung up the phone and surveyed the progress that the day team had made on updating the list, which seemed minimal.