Frustration on FP Wards

Really the only good thing that has really happened in the past week is:
I got to see my college roomie Cathleen! She was in town coaching her college track team (Univ. Northern Colorado) and I got to meet up with her and her co-coach, Melissa, at dinner on Friday (we had wonderful Thai food at a place called Thai Fusion on Howe). I think she would have been a bigger fan of California if it hadn't been...101 degrees. Yup. The weather changed, suddenly, just in time for her visit (felt so bad for her athletes!)!



Secondly, I want to wish a congratulations to my sister who, today, became "Master Arness" at her graduation from GW's Elliot School of International Affairs. Sorry I couldn't be there, sis. (And, speaking of graduations, congrats to Rachel who graduated from Dental School on Friday and Molly who is now a Mayo M.D.!).

Everything else is basically driving me crazy.

A week or so ago, it was trying to do a fundoscopic (ophthalmologic) exam on a patient admitted to rule out noncommunicating hydrocephalus to check for papilledema. She was sent over quickly from clinic to a room which did not have a wall otoscope-opthalmoscope set (some rooms do).

"Where can I find a portable ophthalmoscope?" I asked the clerk.
"Ooh," she said. "I don't think we have those on this floor."
"Hmm. Do you know a floor that does?"
"Maybe the neuro ICU has one," she offered. She tried to call a bunch of floors but they had none.
"This is a hospital. This is crazy! Even the VA hospital has them sitting around nearby. What am I going to do?" I wondered.
"Why don't you call ENT?" she suggested.
"ENT? Call the consult number just to ask about an ophthalmoscope?" (It would be ophthalmology anyway, not ENT). This seemed quite ludicrous.
I paged Michelle, who is on neuro, to see if any of her neuro buds carried around portable ones.
No luck.
30 minutes' worth of hunting later, I buckled and called the Ophtho resident on call. I felt stupid, although he was very nice.
Very nice in that he said, "I would offer to loan you mine for a quick eye exam...." .... except that he, like most ophtho residents, was not in house (why would he be? It was Friday at 2 p.m., practically the weekend!!).
He suggested taking my patient down from her room to the ER where they have some wheeled ophthalmology carts.
I wasn't a big fan of that plan. The ED at our hospital is crazy.
I realized that Tower 4 has the wall sets. I wondered if I could walk my patient over there to just "borrow" the wallset for a minute.
"No, all of our rooms are full," said the clerk. "You can't just bring her into someone else's room."
"Are there any rooms temporarily vacant while someone is at a procedure or radiology where I could just borrow the space quickly?"
"Well.... yes," said the clerk. "But you can't go in there. They are isolation rooms [for c. diff- a stool pathogen]."
"What if we don't touch anything??!!? We'll gown up and wear gloves, and everything! Please, please, please, please, please???!"
"Well- I guess it'd be okay," she relented. "But be quick."
"Thank you, thank you, thank you!"
So I walked (well, practically ran) my patient to the unit to use the on-wall set.
The scope wasn't working.
Oof. I could not believe I hadn't tested it first.
Luckily, by some miracle of God, I was able to fiddle with the neighbor's wall plug (he, by some miracle, also happened to be out of the room) and, all gowned up and everything, finally did my eye exam, which took all of 2 minutes (this was about 75 minutes later).
What a waste of time.
But there was no papilledema.


Basically, this whole month I've been frustrated by the inefficiency of the hospital system and by people not doing their jobs. I really have learned very little about medicine. It's all about coordinating w/ discharge planning, getting people home health antibiotics, figuring out the bugs in this new EMR, etc. I could tell countless more stories, from the EMR havoc when the nurses are somehow not being able to release the orders (esp. discharge orders) we've signed, to frustration on rounding every day on people in the hospital (one patient there for almost 2 months) who are only there for placement. Or the orthopedic surgeons who wouldn't take a hip fracture patient onto their service, saying "she has too many other medical issues" (like being old, having a UTI, and having a heart rate, basically). Or the people mistakenly admitted to our service who are not even family medicine patients.

It's okay when the service is light, but we've had between 8-13 people, 2-3 admissions and discharges per day, almost every day for the past 3 weeks. I am waking up at 3-4 a.m. most days to go in (sometimes to run before work; this weekend just b/c there were so many pts to see and write notes on) and worked both days this weekend since I had both days off last weekend. It's draining. It's unsustainable.

OB (my LAST month [!!!!!!] of the calendar intern year [!!!!!!- although I have some intern peds to do in the fall],which has typically been very stressful and tiring on previous times) will seem like a breeze compared to this past month, which has been really the most work and longest hours for the least yield that I can imagine. One more week of this madness. Can't wait to be done.