Called it!

So, I went into my last shift as a resident just kind of knowing that things would suck, and boy, was I right. Please remember that I wore my cowboy boots for my last shift. Right after I arrived, the lab's electronic resulting went down. It means that lab results had to be delivered by hand. With a large hospital like mine, this means that the lab techs slow down as they have to split their time between doing their job, and physically writing down the demographics and results of each test, which slows the lab waaaay down. So, urine results, which normally take about 40 minutes from send to resulted took 6 hours. Cardiac panels were out for 8 hours before we got them back. I ended up changing my workup to rely more on imaging than labs. Made a *lot* of decisions based on clinical acumen. They worked out pretty well. I did press the lab once to call me with the results of one patient's labs STAT, and I got them back in fifteen minutes (TYhis is one of the few times when being an emergency medicine physician and saying STAT means that the tech running the lab stops whatever the f--- he is doing, and focuses on what you want to make happen). the two values I wanted were for the patients INR (a measure of how nuch they bleed) and the hemoglobin (a measure of how much blood they have). The guy had fallen and broken his hip. His INR was twice the normal value, and the hemoglobin was half the normal value. The ortho resident told me she was amazed at how nonchalant I was after I had relayed the case to her. I just smiled chuckled and walked off with my boot heels marking time. I didn't say what I was thinking; "I'm emergency medicine, sweetheart; I don't get spooked." Of course, her reaction was the opposite of the idiot senior surgical resident's reaction. I had relayed through their intern the facts of the same case.  When I talked with the senior he said that the GI bleed was a deductive leap of faith based on the guaiac. "you don't know that he has a GI bleed! The guy could have eaten a steak for dinner!' he said (rare cooked steak is a cause for false positive guaiac results). My retort was short. "The guy's Hemoglobin is 6.6. His INR is 2.1 I don't think that the positive guaiac is because he had a steak." I turned my back on him and walked out. Idiot.

I *almost* got to do a Burr hole on a gal. Almost except for the fact that the Nuerosurgeon got wind of the case, and was present. He took her to do it in the OR. *THAT* would have been a spectacular way to end the residency. As it is, my Residency is over. I have a lot more to say on that later, but for right now, I am going to go to bed.

...and the alarm clock be damned.

Respectfully submitted,
-doc Russia