Ophtho Consult

I had to call an ophtho consult today. Which was greeted in the usual fashion, with an ophtho insult. So I'm on the phone, trying desperately to convince the woman on the other end that the patient (acute unilateral orbital swelling and erythema with chemosis and ptosis in an immunocompromised host) needs to be seen today, while she tries desperately to convince me that I'm probably wrong about the severity (her indications for not needing an urgent consult included "it's Saturday" and "I'm not in house right now"). Ultimately she said for eye swelling she recommends cool compresses and that if the patient still needed to be seen tomorrow I should re-consult (aka call back tomorrow when someone else is on call).

After she rudely ended the phone call, I had two choices. I could either document in my note the conversation we had (basically find a proper medical (ie, verbose) way of saying "I told the ophthalmologist what was going on, she blew me off, then made me feel bad, and still refused to see the patient. Oh by the way, this is her name for medical-legal reasons should we all get sued some day.") OR, I could take whatever is left of my pride, wadded up in some deep pocket of my white coat, and sacrifice it up as an offering to appease the consult gods by calling back and BEGGING the ophtho to come see this patient today.

I went with option B. She actually seemed quite receptive on the second go-round, even apologized for being "brief" with me earlier. She whined that she thought I was just trying to rope her into doing "another consult for eye exam" which she had been getting all day. I assured her I was not, and again emphasized that orbital cellulitis was high on, if not sitting on top of, our differential. (Puhlease- I'm not going to consult ophtho just for a fundoscopic exam! I know how to use an ophthalmoscope just as well as the next one. Which means if I need to evaluate for papilledema I'm going to do it the true inpatient medicine way- and get a head CT.)

Four or five hours later, she finally came to see the patient. She immediately called me back and confirmed that this was likely orbital cellulitis. FUCKING A. She then also went that extra consult mile, and covered her ass by volunteering to the attending the only reason she came so late is that I hadn't relayed how serious this was over the phone. This was funny because (a) I hadn't even complained about her to my attending, because I thought that would be unprofessional, and (b) my resident was right next to me for the entirety of my TWO pleading phone calls and heard every word that I said. His assessment succinctly summarized the situation, the day overall, and frankly my life.

"Bullshit."