Whiplash and Teamwork

Whiplash

After finishing up a wonderful couple of months in the ED's of Massachusetts, I headed back down for my September Geriatrics rotation in the Bronx. One of my EM attendings predicted it would feel like whiplash...and it has!

Talk about polar opposites of the health care spectrum...I went from managing 7-8 patients per shift from presentation to managing 1-2 patients at a time...without the ability to do ANYTHING. Not look at labs, not order tests/meds/care, nothing. I stand on rounds for 2-3 hours per day, drop my notes and suffer through the seemingly endless didactics (over 12 hours per week). Not only that, but I am the only student in the Medicine Department right now because the third years just finished their medicine rotations. I looked around the room the other day during grand rounds and I was one of three native English speakers in the room...great.

Teamwork

Ok so it wouldn't be aweful if I didn't deal so poorly with being scutted in it's most evil form. I don't really mind doing blood draws, IV's and rectals on other people's patients, but most of the patients I've been assigned have come from the interns on their last day of hospitalization...so guess who gets to do the discharge paperwork. Yeah...that's right...me! Here's the kicker: I'm not technically allowed to sign the discharge papers or fill them out.

Well that caveat came back to bite the entire service in the arse. I picked up a patient for maybe 3 hours, presented on rounds and took care of the last minute social work, got the discharge meds from the resident and put the discharge summary in the chart. I notified the intern that the papers were finished and in the chart. Well, she never signed them, the resident never signed them, the fellow never signed them, the attending never signed them and the charge nurse made sure the patient was on his way out the door. Well the nursing home was a little bit upset when they didn't see anything signed and that there was a little bit of a heftier dose of ampicillin than usual...so they called to double check on that. And so my team proceeded to throw me under the bus...yes it was my fault for not double checking the resident's dosing, not waiving the discharge papers in front of everyone to sign and not signing the document that I'm not even supposed to fill out.

There's my other scut. Working in NYC exposes you to all sorts of races, languages, beliefs and sexual practices. We were rounding the other day and one of the Spanish speaking patients is screaming that he wants a sleeping pill because he hasn't slept in like 3 days due to his pain...en Espanol of course. So forgetting that I was the only one with any sort of western language skillz, I accidentally translated what he was saying...my big secret came out. Yes, I can understand and speak some limited Spanish. All of a sudden, I am translating for EVERYONE.

Ever tried to get a history from a demented old man with an old stroke in a language that you only sort of understand? Ever tried to take a history in a language that is not your own for a hematologist? Ever tried to explain an AV-fistula surgery in Spanish?

Only one week of this left...I've never been so happy to leave a service.