Friday, November 19, 2004

My Differential

My CCU team, composed of one Resident and two Interns is smaller than my previous entourage, still, it is a cohesive group ideally designed to optimize patient care. As always, medicine is the backdrop for our overly human delinquencies.

My first intern “Overworked” is a brilliant young lady who recently moved to this country from overseas to fulfill her husband’s (she hates it here) career goals. She knows TOO MUCH and rarely listens to anything I have to say. Unfortunately, she has terrible luck and maxes out on admissions whenever she’s on call. We’ve redistributed patients multiple times to even things out. Usually, those that were redistributed spontaneously heal and leave (The so called DIFF effect) .

In spite of her incompetence “DIFF” is loved by her creator. We were on call yesterday when we had an admission of a fifty year old man after a bad heart attack. His MI was severe enough that he was rushed to cardiac catheterization before coming to the CCU. After placing a few stents in the arteries that supply his heart he’s doing somewhat better. While we were taking a history DIFF asked what type of pain it was? Was it burning? Was it sharp? Did it improve with Tylenol? Who the hell cares! What is she doing? There’s no DIFFerential diagnosis for a guy who went to the cath lab and left with two stents. There just ISN’T!

The Master of Lines (MOL) is our Attending and so named due to his above average (way above) ability to speak magic when analyzing an E.K.G. Electrical vectors reveal galaxies in this man’s eyes and I am constantly amazed by the amount of information he can deduce from this simple tracing. Over the last week I have dedicated hours to perfecting this art once even teaching MOL something he never knew, COMMISH (check side dictionary) would have been proud.

On morning rounds Overworked and DIFF were trying to analyze an interesting EKG. Thus two interns analyzing an EKG, a true double blind study. Upon handing the tracing to MOL he diagnosed third degree AV block that had gone unnoticed by the entire staff (side note: with rapid junctional response for my cardiac junkies). He then took a whiff of the paper as if it was a fine Cuban cigar, turned to me with a coy smile and said “and halitosis”.

No way!

Of course, as soon as he turned the corner I ran back to my patient, toothbrush in hand.