The benefits of being on night float:

1. The opportunity to wear a skin-tight muscle shirt and scrub pants in the hospital.

2. Not having to dictate discharge summaries.

3. Cancelling clinic.

4. Less work.

The detriments of being on night float:

1. Vampiric lifestyle.

2. Cleaning up the mess made on someone else's patients.

3. Four admissions in a row at 3:30am.

4. Getting paged relentlessly for really stupid things.

I am sooooooo tired, but I survived a long, drawn-out month of CCU!

See? See? I'm still smiling.... At least I was for the ten seconds it took to take that picture.

So let’s review a couple of the things that my doctoring skills have brought forth:

1.  76 year-old female with a past medical history of Diabetes, Hypertension, Chronic obstructive pulmonary disease, coronary artery disease status post Coronary Artery Bypass graft five years ago, Class III systolic congestive heart failure with an ejection fraction of 30%, presents with altered mental status, bradycardia, and bradypnea.  Her medications included, but were not limited to, Aspirin, Carvedilol, Lisinopril, Amlodipine, Lipitor, Coumadin, digoxin, Lasix, and hydralazine:

And she was like:

No, seriously, I shit thee not,

So I was like:

$5000 Miracle on yo ass!

And, within two hours, she was like:

Hells yes.

2.  You know how they all say one never ever ever sees the classic EKG pattern for pulmonary embolism?  Well, they are all wrong:

Yesh, finding this baby got me a whole lotta nurse-love.

And that is the actual EKG.  Recent fracture, resting dyspnea, oxygen-remediable hypoxemia, frothy blood-tinged sputum, Q1T3S3, new RBBB, caved T waves in anterior leads Cu-Lass-ICK.  I dropped tha Heparin wit da kwickness.  And then I got the CT:

Yeah, "holy shit" is right.

3.  Subvalvular Hypertrophic obstructive cardiomyopathy, Eisenmenger’s Syndrome, aberrant coronary arteries, therapeutic hypothermia, Broken Heart Syndrome: the pathology here is insane.  I treated some massive MIs that would cause a red-alert-fire-drill at most other hospitals but barely raises an eyebrow here.  It’s been a hard month, but I’m very glad that I matched here.  Nothing spells gratification like shocking a patient out of torsades arrest three times in one night and watching him survive to discharge fully functional.

4.  Nothing at work, however, would be satisfying if my life outside of work were not a good experience.  July, for me, was a month to build my arsenal of recipies.  I haven’t eaten out for dinner once this entire month.  No, I’ve managed to cook dinner for myself every night, despite my busy schedule. I’ve got the most fantastic recipes on earth, and I eat like a prince.

Two nights ago, I made Chicken with caramelized onions and sun-dried tomato on whole wheat pita:

And, how did it taste?  Fucking delicious.

Last week, I made filet cutlets sautéed in extra virgin and thyme:

And, how did it taste?  Fucking delicious.

The week before that, I made ham Panini on 50-calorie flatbread.

And, how did it taste?  Fucking delicimafuckinfkja;kous.

Thusly, the conclusion you should draw inevitably from this post is that I, clearly, am better than you.

*wink.

Being on call q3 (every three nights) is brutal, and my supervising resident is a genuine asshole, an insecure brown-nosing beta male who looks like he’s having a TIA every time I showcase my knowledge in front of the attending.  I don’t mind him too much, though, as I’ve begun the buddy-buddy process with my chief resident since day one.  I work hard, learn fast, am very likable, put in extra hours, and have great confidence in my own knowledge and abilities; and, most importantly, I take responsibility for my own errors.  When I'm supposed to get something done, and that something is not done, I don't pass the buck to my subhordinates.  That's how I was treated as a student during many of my rotations (especially surgery), that's how I'm being treated now, and that's never how I'll treat my students. 

I also dress 50x better than he ever could, and the hot nurse can’t seem to recall the last time she ever gave his ugly ass a kiss. <-dope rhyme  

So he can, with all grace, take that weak shit back to the fugus-laden rock from which he slithered.  His flabby ass can’t step to this. <-dope rhyme

On a lighter note, I still get lost in the hospital every day.  The facility is a massive, multi-building labyrinth connected to the medical school and the outpatient clinic, and I am loathe to venture anywhere outside of the path form the bathroom to the CCU to the cafeteria.  I am surprised there isn’t a Minotaur running around the place.  Hell, I can barely manage to locate the ER.  This is why it sometimes takes up to fifteen minutes for me to answer my pages: it’s because I’m fucking walking around in giant circles trying to find a phone.  I feel like a moron.

Speaking of pages, I wish the nurses would stop blowing up my digits like it’s nobody’s business.  I’m getting paged for some of the most inane shit one can imagine, like, “doctor, the patient’s order for docusate wasn’t signed!”  

Kadnfl;kejnfa;jkd

Still, I love all my nurses, even the feisty ones…. especially the feisty ones.  They have years of experience and are a godsend whenever I forget a medicine’s dosage, or need a stat blood draw, or even when I need a shield from frustrated and unreasonable family members out for blood.  They are the polar opposite of the nurses I’d encountered during my rotations at medical school, who not only slacked off brazenly on the job, but would actually fight tooth and nail with the attending.

I *heart* nice nurses.

Likewise, nice nurses *heart* that, which is I.

I’m on call again tomorrow.