Two nights into my night float and I must admit that I am overwhelmed by the serenity it has bestowed upon my soul. Having absolutely no responsibility for future results and not having to deal with the complications that will later arise has served me well. The medical admitting resident and I have become great friends. Together, we ponder over our futile attempts to divert bullshit admissions and how hopeless those attempts really are. We theorize over the judgement used by the Emergency Room doctors to rationalize their admissions and we have come to a hypothesis that it goes something like this: In a world where medical school is a business and everyone is just covering their ass is there really any room left for logical medical decision making? The answer is no.
Now, the medical Admitting Resident (AR) calls me from the Emergency Room and our conversations go something like this: (Just a general reminder, this is three or four in the morning)
AR: “Madman, I have a patient for you”
AR: “Ms. R is a forty year old female”
M: “With Chest pain right?”
AR: “How did you know?”
M: “I know her, I had her one my team last month. We have a documented catheterization that shows clean coronaries. She’s just a nutcase with a lot of social issues and she’s addicted to narcotics. She’s manipulative and a general liar. We practically had to get hospital security to remove her from the hospital after she wouldn’t leave on her own”.
AR: “You mean you have the report that says she has nothing in her heart!”
M: “Absolutely nothing! In general, she just wants someone to prescribe morphine and codeine and she’ll only make some poor interns life miserable for the next week”.
AR: “Well, let me talk to the ER docs and see what they say, I’ll call you back”.
One minute later the phone rings.
AR: “She’s coming in”
M: “What? After all I’ve told you she’s still coming in? Let me guess, they think she has a genetic mutation that causes her arteries to clot over days”
AR: “No, after I told them what you said they want to admit her as a social admission”
We both just started cracking up. You really can’t make this stuff up.
The truth is that at four o’clock in the morning it wasn’t as funny as when I look back on it. Of course, I punished Ms. R for the pain she would cause poor intern. I did three rectal examinations that night, just to rule out acute excessive rectal bleeding in a women with non-cardiac chest pain (hey, in a genetically mutated individual you never know). I told the intern to tell her to run up and down the halls every day for ten minutes- to prevent a venous clot. Of course, I wrote “DO NOT GIVE PAIN MEDICATION” all over my admission note.
The beauty of night float: She’s now someone else’s problem.