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.
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...
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.
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.
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?
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.
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.
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.
Psychiatrist: Do you know who the largest consumers of DSM manuals are in the United States?
Psychiatrist: They put it to good use.
After putting in an IV.
Anesthetist: You have very steady hands, Tom.
Me: Thanks. Years of playing music perhaps. And lots of practice.
Anesthetist: No, really you have very excellent technique. Very deliberate and effortless. You seem to excel at this procedural work.
Me: Why thank you.
Anesthetist: Have you considered a career in anesthesia?
Me: It has crossed my mind befo...
Anesthetist: You should consider it. Let me know if you need a reference.
While working through a case study.
T: ...So the DRE was positive for blood, so what would be the next investigation you would like to do?
H: Release the black mamba.
P: Did you just refer to a colonoscopy as the black mamba?
T: That is seriously disturbing.
P: And it has a wicked bite.
H: Well we take bites of tissue for biopsy purposes on colonoscopy so it is close.
P: No. No, they are not even remotely close to being the same.
T: Oh man, I cannot get that image out of my head! Ah!
Doctor: I need to make a phone call but you can go ahead and see this patient first.
Me: Sure thing.
Doctor: It is a child querying RSV. Go.
Doctor: By the way, the thing with children is to be gentle. If you make the child cry, I will flunk you.
Doctor: I'm kidding. Sometimes you have to make them cry. *chuckle*
Me: ...*laugh* Right.
Doctor: No, seriously. Just go.