Posts tagged chat

Recorded

  • Me: Is there anything else that is bothering you?
  • Patient: I have been recording some conversations.
  • Me: ...And you understand that that is not legal?
  • Patient: ...Yes.
  • Me: ...Alright.

Death is a Continuum

  • Palliative Team: Do you know anything about or have ever considered hospice?
  • Patient: I know what it is but I am not interested.
  • Palliative Team: May we ask why that is or what you understand about hospice care?
  • Patient: Once you are in hospice, you are dying.
  • Distinction: Being in hospice does not initiate the process of dying. Death is being driven by the underlying disease. This is a common misconception and the role of hospice in the care of dying is an arbitrary distinction. The care of the dying can happen in hospice, in hospital, or at home.

Starbucks-Hopping

  • Day One. Starbucks #1
  • Doctor: Tom?
  • Me: Hey doc. How are you doing?
  • Doctor: Not too bad. What are you studying there?
  • Me: Just some surgery stuff. Exam is on Friday.
  • Doctor: I see. I will leave you to it then.
  • Day Two. Starbucks #2
  • Doctor: Tom?
  • Me: Doc? Fancy seeing you here.
  • Doctor: I was going to say the same thing. What are you doing here?
  • Me: Just waiting for my friend. We are going to study together in a bit. Yourself?
  • Doctor: Was out for a jog and needed a drink.
  • Day Three. Starbucks #3
  • Me: Doc!
  • Doctor: Ha! This is ridiculous! No Starbucks in this town is safe! Quit stalking me!

In the Dark

  • On call. 3 AM.
  • Resident: Resident on call.
  • Nurse: Hi. I have a 35 year old lady who came in with a cellulitis and a really soft blood pressure of 95/60. I would like to bolus her with some fluid.
  • Resident: Um...can you tell me more? What is her blood pressure usually like?
  • Nurse: Her usual blood pressure is in this range too.
  • Resident: And is she feverish or tachycardic? What is the rest of her vitals looking like? Is she stable?
  • Nurse: I don't know. I was going to do the rest of them after this phone call.
  • Resident: ...
  • Nurse: ...So can you bolus her with some fluids?
  • Resident: Does she look dry?
  • Nurse: Maybe? I'm not sur...
  • Resident: I will just come up...

Breaking Even

  • Patient: I swore to myself, "You better live to be 150!"
  • Me: That's a ripe old age! Why 150?
  • Patient: It's because of all of my pension, medical benefits and coverages. I figured, for all the years I paid my taxes, I cannot die before the government pays their due diligence and covers me for all of my future medical problems.
  • Me: I see.
  • Patient: I did all of the math already, you see?
  • Me: To break even? At 150?
  • Patient: *Serious tone* That's right. If I die before that, the government wins.
  • We share a laugh.

Run the List: Things Internists Say in a Day

  • 0700: Did someone print off the list?
  • 0705: Alright everyone, let's run the list. Who's seeing John Smith?
  • 0715: What are the new issues?
  • 0716: What's the disposition? He needs to be gone. Today.
  • 0720: That's a pretty good thought...but what else?...what else?...
  • 0721: Give me five differentials for what might be causing his constellation of symptoms. But preferably ten.
  • 0730: Aright guys, we will meet here after lunch and run the list for any problems.
  • 1150: Hey guys, I know it is a tad early but I want to run the list before we grab lunch.
  • 1230: I forgot about the cheaper test. Going for that PCR would be like sandblasting a soup cracker...Let's keep it though. It'll be more specific.
  • 1231: Tell me about the sensitivity and specificity of this test.
  • 1235: Do you think that this is the best test? Rhetorical question. There was this study that just came out a week ago...
  • 1300: What's interesting is that there was a clinical trial that came out 60 years ago that established this called...
  • 1310: Good job team. Go get some food.
  • 1430: Incoming text: Attending is here. Let's meet on the unit and run the list for him.
  • 1450: The diagnosis fits! It explains everything. Treat him then transfer.
  • 1745: Incoming text: Has anyone seen my list?
  • 1747: Incoming text: Never mind. Found it. Let's run the list guys.
  • 1900: Good job team. Go home and get some dinner. We'll run the list tomorrow at seven.

Call Me Maybe

  • Me: Perfect. There are no residents on maternity call tonight. I might be able to deliver some babies.
  • 1700
  • Me: Anything happening on maternity so far?
  • Nurse: We have two ladies who might deliver tonight.
  • Me: Okay. If they start to go, the baby is on its way out, give me a call. I left my number on the call board. I will check back later.
  • 1900
  • Me: How are they doing?
  • Nurse: Nothing so far.
  • Me: I am on call tonight for the hospital so I will be around. Keep me posted.
  • Nurse: Sounds good.
  • 2100
  • Me: Any progress?
  • Nurse: Nope. Both around 4 cm dilated. Do not worry. We will let you know if they are getting close.
  • 0100
  • Me: The ward is quiet.
  • Nurse: Yeah, they are 6 cm dilated but now progressing really slowly. I think they are both resting at the moment. No developments for the last hour.
  • Me: Well, I am going to go nap for a bit but give me a call if something happens. My number is on the whiteboard.
  • 0315
  • Me: Just finished seeing a patient on the ward. I figured I would pop by and check how they are doing.
  • Nurse: Oh yeah, everything went beautifully. The two delivered within minutes of each other. No issues.
  • Me: Wait what?

Required Equipment

  • Surgeon: So before I do the colonoscopy, you will have to do some bowel prep.
  • Patient: What does that involve?
  • Surgeon: We give you something to drink and you will need to continue drinking plenty of fluids the day before. This stuff will help you go to the washroom and clear your bowels of any stool. There is no point for me to scope you if I cannot see anything.
  • Patient: That sounds like fun.
  • Surgeon: Oh yes, it is a blast. Take the day off work that day because you will be tied to your toilet.
  • Patient: Well we will need to book it a little later in the month then.
  • Surgeon: Why is that?
  • Patient: I am getting my toilet replaced right now. I will not have a toilet for a bit. It is current backed up.
  • Surgeon: Yes, you probably should. The toilet is sort of the required piece of equipment for this procedure.

A Literal Context

  • Me: As we discussed before, with your dose of morphine, you were more likely to have constipation.
  • Patient: Yes, I know. Is there like a laxative I could take or something?...
  • Me: Sure, we are going to...
  • Patient: ...because I do not want to have my wife tell me I am full of shit and have her be right.
  • Me: Um...of course, we will work something out.
  • Patient: Excellent...

The Wrong Demographic

  • Me: Do you know when the new DSM-V is coming out? I have been considering getting it for future reference.
  • Psychiatrist: Well, at your stage, that is probably not a worthwhile investment.
  • Me: More useful for the resident or the specialist?
  • Psychiatrist: Not even them.
  • Me: Really.
  • Psychiatrist: Do you know who the largest consumers of DSM manuals are in the United States?
  • Me: Doctors?
  • Psychiatrist: Lawyers.
  • Me: ...
  • Psychiatrist: They put it to good use.