I did intend to report another shift to you - believe it was Saturday's night shift, but I misplaced my sheet with all the patients on it and by now it's all just a big blur. I've been sleepwalking a lot these past days.

But let me mention a few memorable situations. All of them revolve around psych cases. There were a lot these past days. For example, let me tell you about the attending on my side Saturday night: Dr. P., a mediterranean-looking guy that I would guess is in his early fifties. He has short hair and wears reading glasses that frequently end up on the tip of his nose, which is why a strap around his head keeps them from falling off. Let me also tell you about the layout of ED1, I don't think we ever described it. ED1 is basically a concentrically-arranged rectangle, about 30-50 beds (depending on the onslaught of patients) in the outermost layer surround four L-shaped desks that form another smaller rectangle in the middle. The desks are shielded from the patients with second, higher tables that still allow you to peek over them and look at the patients though if you're sitting on a chair. So, basically, there's the central rectangle of desks that clerks, nurses and docs use to hide behind, about 1.5 meters of space around that, followed by the foot end of the beds all around us. So I was leaning on the high table across from Dr. P. labeling and packing blood from a patient, while he was apparently busy writing up the discharge forms for another patient. At one point, he paused, realizing he needed something to complete the form. Lowering his reading glasses to the tip of his nose, he turned in the chair, with the pen still in the right hand, arm stretched out in a big inviting gesture, looking back over the desk behind him all the way to the far side of the ED, he yelled: "do you want to kill yourself?" Needless to say, several sets of eyes converged on the attending, including the ones of the patient in area 17 that he was gesturing to and looking at. The patient replied with a "no" that sounded like he himself was checking off a box. Without pause, the attending continued "do you want to kill anyone else?" - "no." - "allright." and Dr. P. went on completing the discharge papers while I asked him from across the counter whether that was his psych eval. He replied "this is my mini mental state".

On Monday morning, when the assistant chief Dr. B. was attending on my side, a mere nine patients were signed out to us from the night shift, they had apparently managed to discharge a lot during the final hour from 6-7a. Bed #4b had a cc (chief complaint) of wanting to kill himself and others. #5a's cc was that her husband was shot by her neighbor, which she apparently always claimed when she forgot to take one of her 12 (sic!) psych meds in the morning. #5b was a seizure, tbs (to be seen, meaning she just came in). #6a had gastritis, #6b was feeling depressed with a PMH of schizophrenia. #7b, a 14-year-old F, tried to hurt herself by ingesting 6x600mg of ibuprofen. #8b was there because he was .. well, guess. Agitated, depressed and suicidal. Bed #9 had presented with a cc of "feeling troubled", PMH of schizophrenia and a flight of ideas on physical exam. Bed #10a had "only" epileptic seizures. So that was 6 nutcases out of 9 patients right there. I was later told we had another 9 looneys in ED2. It must have been a full moon or something. At least people kept their humor. The attending Dr. B., is usually a very down-to-business type of guy and not someone who would randomly joke around, but when a nurse tried to talk to him from the right while I was presenting a case to him on the left he said to me "wait a second, I am hearing voices in my third ear".

Later on that shift we had one very disturbed but very sympathetic African-American nutcase who spoke very calmly but relentlessly and very peacefully informed anyone who would listen that he was the platoon leader of "this unit" (gesturing to the patients left and right of him) and inquiring why we didn't seem to remember how he picked us up with his helicopter near Hiroshima. Oh yes, this tall and slim black man was indeed a Japanese platoon leader. He did go on to talk about black and white people - I think - throwing a small piece of cardboard around, which apparently was very meaningful, because whenever it'd land on the floor, he would declare something obviously very important like "yellow". And he never stopped talking while we were doing rounds, which coincided with his arrival, around his bed. His voice remained very sympathetic and calm until we converged on him accompanied by a big, big security guard. The platoon leader's voice got a bit worried when he first declared "this man is going to hit me, isn't he" then confirmed twice that he is going to comply and curteously allowed us to send him to dreamland.

In other news, Trillian (formerly known as vertigo girl), skriehma and I agreed that we need to print shirts to wear in the Bronx that would say
Please don't kill me
because I'm white.
Find a better reason.

The plan with the cute resident taking us out on Sunday failed apparently due to the fact/excuse that her computer died. Hopefully we can reschedule. Yet this weekend we're going to Vegas, baby!

Today's Wednesday already. Trillian accompanied us to conference where after relieving a few more piano cravings the quiz with the usual teamwork ensued, followed by rather lengthy lectures, drug lunch and some more football throwing in Central Park I am now home and very hungry.

Friday night

It was really by the amount of people still pouring in at 2am that I realized it must be a weekend night.

I'm sitting on the sofa with the notebook in my lap in the abandoned apartment I just returned into. When I came home, light was burning in the living room, a half-full glass of milk, the bottle of milk, a bottle of juice, a half-full glass of water and a tomato were on the kitchen table. It seems like people left in a hurry. The milk was still cold, so it couldn't have been long ago either. If they ever return, I may find out what caused their flight. Oh and if you're wondering why I didn't come home with skriehma - that's because I stayed behind to play piano again.

But back to yesterday's, our last Friday-night-shift (sniff). Started out by having one patient signed out to me by the late shift's medstudent, a 41 y/o HIV+ F with coughing x1wk. She already had a bed upstairs assigned so there wasn't much for me to do.

My first own patient was a 56 y/o F c/o a sudden-onset, burning abd. pain to the RUQ (right upper quadrant) x3d, which has not been getting better since, only worse with movement or palpation. She had visited the ER four times this year before for the same symptoms and was scheduled for a CT in a couple of days. She also vomited once that day (which was still Friday). Currently she had no n/v/d, no fever, no chest pain, no urinary changes, just a headache x1d. After we ruled out most emergent causes of her pain with the clinical exam, labs and a chest x-ray and when her pain responded to medication, we discharged her recommending follow-up with the clinic for possible gall stones. Actually this is what I find to be one of the best parts of working in the ER - all you have to do is find out whether the patient has something serious, if so, treat him/her, if not, give him/her supportive meds if applicable and send him/her to see a doctor or clinic later. You may object that this actually implies chickening out of seeing every patient's diagnosis and treatment through to the end, because after excluding all that can kill the patient quickly you leave the delicate work of diagnosing and treating the correct underlying ailment up to others. But yes, I find it very pleasant to only have to make sure the patient presenting with, say, RLQ abdominal pain does not have an ectopic pregnancy, appendicitis, abscess, ovarian or AAA bleed, kidney stone or UTI (urinary tract infection) and whatever else can be serious enough before discharging them to have the clinic find out what the hell is wrong with them. Even though you are not diagnostically following the patient all the way through, you get to use your diagnostic skills on the subset of diseases made likely by the patient's presentation. This makes the hope of being able to identify and treat all "acute and relevant" diseases more realistic. Of course it would be nice to finally be able to tell the difference between all those annoyingly complex rheumatic diseases and become an attending in internal medicine - but I find it even more appealing to practice telling cardiac tamponade and tension pneumothorax apart (which an internist could, of course, do as well), yet at the same time being able to distinguish a hot appendix (surgical) from an ectopic (gyn), an abscess (internal) and a slipped disk (ortho/neurosurg) without having to call for a consult on every patient. Anyway, the 56 y/o was discharged, feeling well with Dilaudid (hydromorphone).

In between a few drunks whose chief complaints ranged from "what am I doing here" to "let me goooo, I'm sooobaaah", one of them finding the soft restraints we put on him kinky, there was a 68 y/o M nursing home resident who decided today to rip out his PICC (peripherally inserted central catheter) and to start yelling at people and a 39 (!) year old stroke alert whose entire left side went limp today after, as we later saw on the CT, suffering an impressive intracerebral bleed secondary to his inadequately controlled hypertension. After the resident's first intubation attempt I heard the familiar bubbly sound of blowing up the stomach, after relocating the tube strong breath sounds only on the right side but after pulling back a bit we were finally golden.

Then a 22 y/o M was brought in as a trauma code with a stab wound to the left chest and decreased breath sounds over that lung. You guessed it - time for a chest tube, the first one I'd see on a conscious patient. I usually got myself a spot on the trauma team (i. e. immunity from being chased away from the patient) by putting the IVs into patients. So I had a front-row seat watching the trauma resident cutting and sticking her finger into the guy's chest, judging from the screams a very painful experience - actually not so surprising though, considering they gave the lidocaine about 30 seconds to work before ripping through his chest. But hey, he probably did want to breathe and get his sats above 85% again rather quickly.

Shortly before our shift started, the ER staff had tried and failed to resuscitate a pediatric trauma code, 12 y/o F hit by a car while crossing the street. The reason I tell you this is because my next patient was the 51 y/o mother of this child who had a PMH of hypertension, which now, to no one's surprise, was exacerbated to 193/126 and a pounding headache. The resident actually asked me what I wanted to do and considering the circumstances, I pleaded for a Ativan (lorazepam) instead of Lopressor (metoprolol), which seemed a more causal treatment. I am by the way writing up and signing for medications myself now, usually, as in this case, running the proposed treatment and dosage by the resident or attending first though, since my trust in the convenience and ease of relying on my malpractice insurance is limited. The attending agreed with 2mg of Ativan and shortly after the nurse gave the medication I found the patient standing amidst what appeared to be family, friends and teachers of the dead girl who surrounded and questioned a police officer about the perpetrator of the hit-and-run. The poor officer's answer that she couldn't reveal anything about an ongoing investigation did not seem to pacify the group (she also claimed that she actually wasn't involved in the subsequent investigation, only the initial response and therefore actually didn't know anything). After I went back to ED1 while they were still arguing I never saw that patient again. She walked out with 2mg of Ativan in her, let's hope she didn't get behind the wheel of any car herself afterwards.

After another trauma code with a stab wound to the back this time (after bullet night this was stab night apparently) I saw my last "own" patient for the night, a 41 y/o M with chest pain and SOB (shortness of breath) that made him "think he was dying" - again - since he had a history of this for years now. Still did the obligatory EKG and cardiac enzymes on him, his EKG admittedly looked funky but was nonspecific for MI and I never saw the results of the cardiac enzymes, because they were looking for someone to suture a large laceration in ED2 and since I had nothing better to do at the time I took the job.

The guy had some AOB and recently put his fist through a window, making for himself the invaluable experience that glass, indeed, is harder than skin. He ripped open his forearm, wrist and hand over about 11cm, the laceration went down to the fascia but apparently missed any major vessels or nerves. Thus, I spent the last hour of my shift numbing up, irrigating, putting 18 stitches into and documenting the care of this wound in ED2, which turned out to be a wise decision since I was spared from the onslaught of apparently more than half a dozen patients who came in between 6 and 7am, but I also missed a code in ED1. That was the mother of a guy who rushed into the ER, stating his mother was in the car and had trouble breathing, "something was wrong with her". Sitting on a stool suturing in ED2 I could only hear what this guy said and later on deducted the mother at some point had a shockable rhythm since residents were yelling "clear!" in short intervals. Unfortunately, this code went like any other we have witnessed in the ER and the next thing I heard was the son crying and mourning. Skriehma told me later though that they were overstaffed with two attendings and three residents working on the code anyway and that there hadn't been room for us medstudents to do anything useful. Then after sign-out rounds came the much-awaited breakfast and piano for me.

By the way, after dodging everything in the past six weeks, I managed to get blood on my pants twice today, in two separate instances.

And my roommates are still not back now, at noon, the milk would have been standing outside for 90 minutes. Should I be worried?

Cease and desist

It has come to our attention that a couple of residents at another New York hospital, totally unrelated to our own, have found this blog and are now under the impression that their three German medstudents on surgical and ER rotations are in any way affiliated with the authors of this blog. Could this be any more far-fetched?

But considering those three may get into trouble for what we write here, we will have to refrain from any further mockery, trashing and badmouthing of residents and attendings until the good folks at that other Bronx hospital realize we're not talking about them.

In other news, TAFKAVG (who still desperately needs another nickname) arrived today. She had to face difficulties with the immigration forms and also has some stories to tell about the flight, but I'll let her tell that herself if she likes to. Right now she's sleeping in Phèdre's former bed, not having slept much before the flight and with it being 6am on her clock now and all. Since I also slept less than four hours in order to get her from the airport, I'm thinking about doing the same. Then again, the next shift starts in 23 hours, so I don't want to be messing things up by sleeping now. Hmmm.

Remember the cute resident who was advising us on nightlife in Manhattan? She just returned from her neurosurg rotation and is going to take us out on Sunday, since we're all off on Sunday night. We do all have to work on Monday morning (skriehma and I are back to days then). Shouldn't be a problem though, since we work until 7am on Sunday, we'll go to sleep around noon, wake up to relieve our hypoethanolemia and let the booze wear off a bit (or not..) before going to our shifts. Not sure what Phèdre is going to do. Bronx attendings on Monday, bear in mind we're probably not talking about the German students in YOUR hospital here.

On to the obituaries - Greg died. Autopsy results are still pending, but he suddenly became paraplegic and expired shortly thereafter. Resuscitation was not attempted due to a DNR order, Gregs remains were later consumed by his littermates leaving only the tail and a few patches of fur, making the coroner's job exceedingly difficult. The DA was called and Michelle and Del are now awaiting trial for obstruction of justice.

Not to worry though, skriehma tells me more non-confined quadruped vermin has been sighted roaming the appartment.

Another long day.

I know I shouldn't be doing this since I have 6.5 hours until skriehma's alarm clock is going to rip me from my dreams but I do want to jot down some notes on these past 20 hours.

Firstly, we were not supposed to work yesterday and this morning, since we're supposed to be "awake" for conference from 7a-12p this morning. But since The-Artist-Formerly-Known-As-Vertigo-Girl (we need a shorter and cuter nick) is going to arrive on Thursday, we spontaneously decided to ask Dr. G. to switch Tuesday with Thursday and work yesterday. The official reason we gave was of course that we wanted to avoid sharing the EDs with four other medstudents again like we did on Monday night. It worked, we were just three total last night.

We got up two hours earlier than we had to yesterday though, to be able to watch House from 9p-10p and the season premiere of Nip/Tuck from 10p-11p before our shift started at 11p. The House episode was strange and not that enjoyable (and we had to fend off an attending who insisted on watching some "finale" of "big brother" .. crazy Americans) and we could not see Nip/Tuck at all since they didn't have that channel in the residents' lounge.

So we went on to the shift, which was very slow but had some very sad cases. A 23y/o hispanic woman lost her husband and cousin today in what appears to have been a hate crime. She was in the ED since she had "only" been hit in the shoulder while her husband was shot twice in the face. She has been crying all night in her bed, with no one of us, naturally, being able to offer any meaningful cosolation. Another three year old kid who spent the night in ED2 lost both parents to another shootout tonight. At 6:30am a patient came running from his assailants and when I was done suturing his stab wound to the head (tonight was obviously not a good night to be on the streets) skriehma and I had to rush to the Braker Building to take the Rosen's Quiz. There, I realized that actually reading the chapter makes you very cofident in your answers and you start opposing the majority of the people around you. Not a good thing. The board review, lecture by Dr. S. on aortic aneurysms and department meeting afterwards were somewhat enjoyable, but the lecture on dementia by a psychiatrist was simply painful to endure. Luckily we were in the last row and had the support of the other medstudents around us in complaining about the boring lecture, who by the way were taken out of conference one by one today to do their exit interviews.

Allright, but now I really must hit the shower, 6.25 hours until skriehma's alarm clock.

Poker!

It was a good thing we had a little practice with this game at home and even got most of the funny business with the blinds, buy-in and stack-up figured out before we went to Dr. C.'s place to play for real money tonight. Dr. C.'s place, complete with revolving doors, doorman and the works, is on the 19th floor on the East Side of Manhattan. We were 8 ER residents, one girlfriend, skriehma and myself so we divided ourselves up into two tables of 6 and 5. The buy-in was $20, which you got $2000 worth of chips for. During the first hour you could re-buy twice if you were out of chips to a maximum of $60 in the first hour. After that you could stack up with $10 if you wanted.
(I had to pixelize the faces of the residents since I have no clue if they'd allow me to show their pictures on the net.)

Skriehma ran through his first stack of money rather quickly, so he re-bought himself in and - look at that - started winning some money.During the intermission, both skriehma and I had more money in chips than we paid for, did not have to buy more for the final knock-out rounds. Only the top three players of the night would be walking out winning any money, 50%, 30% and 20% of the chips bought. I went all-in and left the table when there were five people left, here's the winning trio.Our host Dr. C., the one on the left, eventually won after being 3:1 behind in the chip count and collected 50% of the chip worth, $175. While those guys were still playing, losers' lounge was on Dr. C.'s balcony, which, being on the 19th floor, had its amenities.Also, while those guys at the expensive table were still battling it out, we opened a second round with a $10 buy-in that I left rather quickly after just a few minutes by trusting too much in my two-pair of aces and tens when the other guy had a set of measly fives that won my all-in.So after me losing - or let's rather say - spending 30 and skriehma 50 bucks in this nice poker night (we *have* to organize these back in Munich), I tried making some more pictures of 42nd Street.I played around a bit deactivating the automatics on the cam and choosing shutter and exposure times myself.After a few tries,I'm rather pleased with the result.So we went and I tried some more on Times Square.

And who would have thought - as I was writing this, the second mouse reared her head again and this time I didn't flinch so we have a fifth member of newyorkblog! As per skriehma's suggestion: Greg (since I'm rather sure it's a he). And right after he joined Michelle in the coffee pot, guess what happened. A third mouse ran across the kitchen.
Needless to say, if we catch the third mouse or if Greg and Michelle really are what I take them for (and if they were both males there'd most likely be blood in the pot by now unless they're brothers) we will need to buy a cage.

Oops. Spoke too soon. We just caught the third. Enter Del, short for Delvon. Now aren't they just peachy.
We did give them the trash can as a new home, coffee pot is definitely not enough for three.

A day in the ED

I trailed two hours behind skriehma after the shift today because I relieved some more of my piano cravings in the empty administrative building on this beautiful Saturday morning. Oh did I mention that they actually had that beautiful piano tuned a week ago? I've been coming earlier before shifts a couple of times now to play.

On the way back I was toying with the idea of giving you all an "accurate" impression of this day in the ED by presenting today's patients of mine to you. The reason why I hesitated to "just do it (tm)" is that someone might construe my disclosing patient information, even if completely anonymous, as a HIPAA (Health Insurance Portability and Accountability Act) violation. I then decided that I could just change and/or switch a few details, making these patients "fictional", since some of their data is intentionally wronged, but not in a way that would alter the impression you're supposed to get from this ED day. When I then saw what skriehma wrote, I wondered why I even care so much about patient confidentiality. Anyway, here we go.

So where do I begin. Maybe with the most prominent patient, comparing her with skriehma's college girls (by the way, he apparently failed to get any numbers from them!) was one of the running-gags among some residents and skriehma's attending. She was a 42y/o F c/o (complaining of) constant, sharp pain to both knees and what she describes as "cracking" sounds when she moves x1d (times[=since,for] one day). +pain down the entire length of her spine, +leg swelling x1wk, +bed sores, +abd. pain, +SOB (shortness of breath), +obstipation x3d, +occipital HA (headache) x3h. She described the pain with a severity of 10/10 (=excruciating), smiling and laughing while she was talking to me. She also had 6 Smirnoff Ice today. Oh, did I mention she weighed 367 pounds? I had to "help" her get into and out of bed several times today. She also complained of some odor down below, she explained that she cannot reach down there to wipe herself after going for a number 2. I didn't dare to wonder about a number 1. Her PMH (past medical history) was significant for asthma, HTN (hypertension) and, needless to say, gross obesity. Her PSH (past surgical history) consisted of one CS (caesarean section) in '86. Her Meds were Vitamins and Iron, Benadryl (diphenhydramine) to go to sleep, Motrin (ibuprofen) prn (when needed) and albuterol prn. She admitted to one pack year of tobacco use and regular EtOH (ethanol) abuse. Oh and cocaine this morning with her sister. One of the two residents on my side scolded me for getting all this history from her, since attention was exactly what she was looking for. And she was right. Numerous times after that I heard the sweet sound of "Honey!" - and when I didn't react - "Doctor!" from her corner, until I had to go there, the residents looking at me with a mixture of amusement and pity. She usually wanted "some more pain medication!" or to be turned off of her bed sores or to help me move her legs on or off the bed. Our management with this lady was to give her the warm bed she was looking for, some weak pain meds (Toradol[ketorolac] and Tylenol[acetaminophen a.k.a. paracetamol], not the morphine she demanded) and a chest x-ray to keep her occupied (the official excuse was to look for edema, since she had been treated for leg edema before). We later attempted to discharge her, but she refused to leave and nobody wanted to fight a 367-pound-woman at the time. She may still be there.

Enough of her, the next patient was a more pleasant 53y/o M c/o acute onset of abdominal and chest pain with n/v (nausea and vomiting) x1 + diarrhea x1 at the same time. He was diaphoretic and short of breath when it happened and at that point I asked for cardiac risk factors, which he all denied, but slipped him for an EKG and drew his blood for cardiac enzymes anyway. If there's one thing I've learned it's that you cannot walk into an American ED and mention "chest pain" if you don't want them to work you up to rule out MI (myocardial infarction). Naturally, you also get a chest x-ray. Just say "chest pain" and before you can say "AMA" people will have drawn your blood, attach electrodes and shoot gamma radiation through your chest. This guy had no diabetes, no hypertension, no hypercholesterolemia, no family history of thrombembolic events, didn't smoke, the chest pain was anything but typical MI. But if I hadn't started the cardiac workup the attending would have ripped me to pieces. The best (/worst) thing about it is that if you claim your chest pain started less than six hours ago, they will also draw blood again six hours later for a second set of cardiac enzymes (CK, CK-MB, Troponin-I) - just in case the event was too recent for the markers to show yet. So by mentioning some chest discomfort while throwing up, this guy essentially bought himself a minimum of 8 hours in our ED (half an hour for triage, history and until the line is in, 6-hour-wait for the second set, one hour for the lab to get the results ready and at least another half hour for us to look at him and discharge the patient). He was still there when I left.

I don't remember the exact order of things, but I think around this time came a double-notification, one trauma alert and one code, the head trauma was handled by skriehma's side, the 73y/o M with PEA (pulseless electrical activity) was brought to us. He had obvious AOB (alcohol on breath), but we never found out why he arrested and ended the code after about 20 minutes of unsucessful resuscitation attempts. There were a couple more trauma alerts, I don't remember them all. There was one pediatric GSW (gun shot wound), one guy beaten up with sticks, one guy just with fists but his face actually looked worse and possibly more that I don't remember during the course of the night.

The next patient I actually saw was a 10y/o boy BIBEMS&NYPD (brought in by emergency medical service and cops) after threatening his brother with razor blades, then running away from mom, drawing a box cutter (one of these knives that come out of the hilt and retract) in a stand-off with the cops (people die doing that). This little boy either had some serious balls or was incredibly stupid. I tend to suspect the latter. The cops reenacted to me how the boy was standing a few yards away from them in a wide stance and reached for his back pocket, producing the box cutter. If he were not the four-foot youngster he is, he would probably either be riddled with bullets or already in jail. The cops were very adamant in asking me to put restraints on the boy (that was actually before I heard the story) and I did suggest this to the resident but he agreed that the boy was very pleasant and cooperative right now and we felt we could handle a 10-year-old. The cops said "allright, but we warned you, if he gets hold of a needle or a scalpel .." and then announced that they would leave soon, depriving us of their protection. I talked to the boy, he told me he ran away because he was under the impression his mom preferred his brother over him (hence probably also the razorblade-thing), he did take the box cutter to "defend against people, there are weird people out there, you know" but denies wanting to use it against cops. He had no medical condition except some pain in the wrists from being restrained, so all that was left to do was to call for a psych consult. Mom had left with her other kids already anyway. The boy was currently being treated with Concerta (methylphenidate) for ADHD, this stimulating medication may well have contributed to his outburst.

Next was a 19y/o M who had had an unpleasant encounter with a baseball bat in the hands of someone who didn't like him. Among my first questions was whether the police was involved, he denied and didn't want them to be. It's always good to see the system works .. anyway, he had some bruises to the back but appeared in NAD (no apparent distress), no cp (chest pain), SOB (shortness of breath), ap (abdominal pain) or n/v. He had AOB (alcohol on breath) and whisperingly admitted to weed and dust (PCP). No PMH or PSH, meds were just Tylenol prn and, again whisperingly, SSIs once in a while. The tenderness I found on physical exam was not very impressive, I slipped him for x-rays but since radiology was taking hours to get him he signed out AMA later on.

Then there was this 45y/o F BIBEMS that didn't complain of anything except being handcuffed and brought to the ED. In a very coherent and intelligible way she asserted that she stood in front of a building trying to light a cigarette, with her car being on the opposite side of the street, when police "converged on her", handcuffed her and "threw" her "into the back of an ambulance". I talked to her before her chart was prepared by the clerk, so I had neither the EMS report nor the ability to check her history in the computer (for lack of her ID-number) when she explained to me that she was a nurse in another hospital, had no physical complaints and felt it was unlawful to bring her here against her will. The only thing that made me disagree with her was that she really didn't offer any explanation for the handcuffs and the transport to the ED. She started to become upset with me for not agreeing that she should leave now and kept asking me what the heck I was waiting for - "the chart with the EMS report" didn't seem answer enough for her. Eventually one of the two residents on my side who recognized the patient intervened, mumbled the word "psych" to me and tried to stall the patient further. When eventually the chart was ready, sure enough, there were several PSY admissions in the computer and luckily the psychiatrist was still in the ED for one of the several consults we kept him busy with tonight.

At about 6am I started seeing my last patient for the night, a 38y/o M BIBEMS s/p (status post) being assaulted and "asked for" money out on the street. He had obviously taken several blows to the head and reported of kicking to his left side, this all having happened 30 mins before. He denied any dizzyness, cp, SOB, ap and n/v. He had no PMH but a PSH of donating his left kidney to his mother in March of this year. Even though there was just some rather mild rib tenderness on physical exam, there was some blood and protein in his urine when I dipped it, so I sent the urine up for analysis and in accordance with the attending slipped him for an abdominal CT, the goal obviously being to prevent him from losing his other kidney at all costs. I also dragged the guy over to ED2 for a visual acuity exam but his vision was 20/30 b/l (bilateral) despite some bruising under his right eye.

The (wannabe-?)"nurse" had meanwhile been sedated with haldol and ativan IM which made her cooperative (read: drowsy) enough for us to start an IV on her, she was going to be admitted. Pretty soon after that, at 7am, rounds started and we signed out the patients that we hadn't managed to discharge yet out to the day shift.

After that skriehma and I had breakfast and then I went up to play some piano. Now I'm back home and skriehma is sleeping already .. again .. getting ready for the next night shift, later today, a Saturday night.

Well that record was quickly beat

16 years with HIV yet still a CD4 count in the sixties. I wonder if that already counts as one of those very few long-term non-progressors.

Congratulations!

Well, well, Michelle, you managed to post exactly the 100th post on this blog. And it was my pleasure to tidy up your mess and refill your food today.

In other news, the weather around here deserves some mentioning - we haven't needed our umbrellas once so far and today it's terribly humid again with temperatures that at least feel above 30°C. Let's hope it stays that way for our visitor from Cologne, who was looking forward for a little piece of summer.

I also have to say that I looooove rotating through shifts. In contrast to skriehma who seems to have serious difficulty with his circadian rhythms, I for my part, who would, given the option, choose for the earth to take at least 28 hours to rotate, am perfectly happy with setting back my biological clock by eight hours every once in a while. This is made for me.

Night shifts really are slower. New things tonight were my first venipuncture on a triple cocktail (HIV+, Hep B & C) and suturing someone carrying the HI virus for more than 10 years.

A new member of newyorkblog!

Introducing Michelle, the female reinforcement Phèdre has been waiting for!

When we finally had her trapped in a corner by me lying on the floor cutting off any escape, we used skriehma's shoe box to trap her after he scared her out from under the radiator. The shoe box had a hole we had stuffed with paper,
which we then took out and connected to a bottle.And there she was! A new member of our family! Michelle!You'd think that after a year of working with them, I should be able to tell the gender of a mouse - but it's really not that easy. This one is tiny, too. I'm still reasonably sure it's a she.And we built her a nice home inside the coffee pot.Michelle immediately felt at home and joined us for dinner.She had some frosted flakes with cheese.

Phone out of order

Due to continued abuse, phone communications are suspended until further notice, effective immediately. This is due to another incident involving an apparently extremely stubborn sister of a female member of our party, her second offense against the phone code in a row and another hissy fit of mine.

In other news, tonight's shift was, like skriehma indicated, very sociable with basically all my (and presumably skriehma's) favorite residents on shift and a lot of fun. I also found fetal heart tones by myself and stuck a needle between someone's vertebrae for the first time.

Right now we're watching reruns of ER on TV, which is so much more fun now knowing the intricacies of the ED's inner workings, with students, interns, residents, attendings, consults, the actual smell of the bums they bring in, the "feel" of a real code and hundreds of other details. It's - who would have guessed - not quite as dramatic in real life, where everybody goes back to business really quickly when a patient expired - and, thankfully, attendings, residents and especially medstudents are NOT ambulating encyclopedias as they appear to be on the show. In many other regards, ER is a realistic show and still fun to watch, mostly, of course, the earlier seasons.

Long day.

Very long, but mostly good, even though it was off to a bad start with the relative-istic terrorist attacks this morning. They picked the right date for it anyway.

That is also why, after I punished Phèdre by making her run with me up the Hudson River to 70th, over to Central Park and down 8th Ave, we went to see these puppiesclose up.And since that wasn't enough, we boarded this old lady againand enjoyed the b-e-a-uuuutiful skyline of Manhattan plus the Ground Zero lights at night,that we all of course threw ourselves in front of.
After these pleasurable ferry trips to and from Staten Island, skriehma and I walked to Bowling Green, where we took a Bronx-bound subway to the Hub in the south tip of the Bronx, raided a McD and had our fast food on the bus trip to the hospital.

The night shift was not quite as busy as Dr. G. had led us to believe. I did start out the shift with a rectal and a foley that I cannot talk any more about since the record is probably already under legal scrutiny. Before I knew any of that I did start stitching a young guy up that I actually ignore the mechanism of injury of. He was apparently a bit younger than me and had some serious AOB going on. And he had a lot of lacerations. I mean a lot. I put 47 stitches into him. 23 on his shoulder, 6 on his chest and 18 on the chin. Including local anesthesia, irrigation and the occasional altercation to make the guy hold still it took me about three hours to suture him, skriehma tells me.

After our shift we trodded down to the cafeteria where we - surprise, surprise - met Phedre. She was still there when we left, not sure if by now, 10:51am, her BREAKfast is over. I do know that skriehma is sleeping in bed over there .. again .. so I'll see if I can do the same after a long, long day. Oh and I'll unplug the phone. Just in case.

She claims she TOLD her family ..

.. NOT to call. She thinks that may make us spare her. Allright, my roommates waking me up at around nine in the morning and then again at around 12 is .. I guess .. unavoidable. But Phèdre's father, sister and aunt calling at 12, 4 and 4:30pm respectively to say "hi" wrecking perfectly good dreams of mine in two out of three somehow makes me wonder about Phèdre's ability to convey a simple, short message like "don't call" in those endless conversations she has with her family. Or the message "I won't be here anyway and one of the guys will be picking up the phone".

You may now be inclined to say "what the hell is he ranting about, 12pm and 4pm on a Sunday are perfectly appropriate times to call". Let me try and illustrate. Our shift starts at 11pm, so 12noon today, for example, is 11 hours before that and 19-20 hours before the end of our shift. If we were still on late shifts, that would correspond to 4am for us. Or take calling at 4pm when we're on nights like it happened twice today. That's like calling at midnight when we have to work the early shift at 7am, like Phèdre. Would you want to wake Phèdre at midnight to say "hi"? Would you? No? So just us?

What makes it worse is that skriehma, who as far as I know was also woken up, actually seemed friendly on the phone. If for some reason I do have to answer that phone because he doesn't, do not expect the same from me. If you are so unlucky as to get me on the phone in the middle of "our" biological nighttime, expect a moment of silence while I take the phone to the bathroom in order not to wake skriehma if possible (because I do care), then some cussing and yelling for a few minutes and a loud crack when the phone hits the ground after being tossed from the third floor.

Phèdre still maintains "but I told them not to call!" - the mere possibility that she may be telling the truth is what keeps me from calling her from the hospital in thirty-minute intervals starting around our biological lunchtime, say, 2am.

That means we will have to find out the phone numbers of Phèdre's family and start giving them a ring at "impossible" times.

Hugh, I spoke. Now gimme breakfast before I get cranky.

Partaaay!

So we did follow the invitation by resident J. K. to his roommate's birthday and we did not regret it. For one, there was a lot of booze.
The party was in the Upper East Side of Manhattan on the top two floors of an apartment building, including its roof. There were some interesting people there, a few from the ED that we more or less knew, a surgical attending from another hospital, a girl who was quite fluent in German, a bunch of Indians (i. e. internal medicine residents) and more. After a while, a few inebriated people decided to dance on the lower level of the apartment.While out on the roof the party went on (this is not a very good shot, but there are very few recognizable faces so I can post it).This is the co-host who invited us, Dr. J. K., trying to get some chords out of the guitar. I'm afraid the poor guy may have had one too many of those excellent wodka-jellos another resident had prepared.At some point, Phèdre and I decided to lie down at the ledge of the roof and look down on the streets below and at Manhattan from our vantage point on the fifth floor. For some reason, skriehma decided to make these pictures of that. Craaaaayzeeee.Anyway, one of the highlights of the evening: one of the Indians decided to barbecue some pattys, making one of the best cheeseburgers I have ever tasted.Man, these things were good. I mean it.I had three of them, before we soon made ourselves scarce, shortly after the weed was starting to circulate. We took our first NYC cab back to the apartment, which I have a several minute long video of that I'd love to share. Alas, the bulky size of it prohibits me from doing any such thing. You'll have to take my word for it.It was a very fast and convenient ride and for about $4.30 a piece not exorbitantly pricey.

Now Phèdre and skriehma are both sleeping and it's only 4:30am. Skriehma's been sleeping for a while. I wonder how/if he's going to make it through our first night shift tomorrow, which he needs to be awake for until at least 7am, if not 8am after the resident's presentation we would have to attend. We'll see.

My biggest concern though would be that those roommates of mine are going to wake me before 3pm tomorrow. Phèdre has been working on and perfecting her stealth technique quite well, there are no earthquakes that wake me, just her mere presence still does. Skriehma unfortunately still creates a 5 on the Richter scale when he moves around the apartment. I guess my sofabed is not ideally placed 2 meters from the kitchen.

Oh well, I think I should stay awake at least another hour or so until 6am, which shouldn't be much of a problem. I guess I have less trouble than most other people dialing back my circadian rhythm. If it were up to me, the day would have 28 hours.

Cheers, people!