HONC HONC, BEEP BEEP!

I hate Heme-Onc with the fire of a thousand suns. For the second day in a row, I got to work at 6am and didn't get to leave til 8:30pm. Today this one fat lazy nurse kept paging me q15 minutes because the patient's husband wouldn't agree with her so she kept demanding that I talk to him, or would say he was asking to speak to the doctor (which I strongly suspect was not the case based on his surprise every time I kept coming over). Finally I refused to come over and told her if she was unable to speak w the pt's husband she could put him on the phone to speak w me. This nurse wasted so much of my time and the other intern's time. One of the issues she paged me for: to tell the other intern not to hang up on her. I heartily congratulated the other intern, I wish I had the balls!!!

Anyway, had my own patients today, plus covering patients for the intern who had the day off, plus admitting new patients, so overall SHITSTORM DELUXE.

Points of shittiness about the heme-onc service:

# The fellow is a ghost
The fellow is like a junior attending; doing his post-residency training in hematology-oncology fellowship. A lot of great learning could be happening...if the fellow was actually ever around to answer questions or help with patient care issues or ANYTHING. Although he's a very pleasant fellow in person, that helps me not at all when he's gone all day and his page-to-response ratio is 2 or 3:1.

# Drive-by attending
The attending is only in house for about 2 hrs a day from what I can tell. She runs around and sees most of the patients briefly, then we quickly run through the list in the fastest rounds in the west. Efficient rounds are great, but as interns we know not a lot about a lot, and we know jack shit about chemotherapy, so maybe we could take a few min to review w the hapless interns WTF is going on and why the chemo plans are what they are?

# You're on your own
Let's review: the attending is almost never there. The fellow disappears after rounds unless he has a new patient for one of us (and selectively responds to pages) so is also effectively unreachable for most of the day. There is no resident. There are just three deer in the headlights interns managing a slew of sick patients. I have recent ICU transfer pts who get bradycardic and hypotensive annnd I don't have any supervision. AWESOME. I had a patient whose life expectancy, realistically, is maybe several months and the family called me in to talk about chemo treatment options. I DONT KNOW. I deferred the question to my attending who I assured the pt he would see the next day, and for TWO WHOLE FUCKING DAYS he told me I was the only doctor who had been in to see him. Jesus Christ!!!! I don't feel comfortable managing these sick pts who have one foot in the grave and one foot on a banana peel by myself, and it's really frustrating feeling like I have no support.

Except the support of my fellow interns. Because we're all left dangling in the wind together, a lot of treatment decisions are reached after a brief discussion involving many expletives where the intern throws out their best guess of what to do, pages the fellow, who ignores the page, and then a decision is reached based on consensus of interns ("yeah.. that's probably what I'd do.") I don't think this is always the best way to go. Three broken cars won't get you to your destination any faster than one broken car...

# Nurses with rescue fantasies
There are two kinds of nurses who work in oncology. The ones who are truly angels of mercy, and ones who are overly vigilant douchebags with delusions that they are the patient's one and only savior. I've got news for you guys: first of all, uhhhh FUCK YOU. Second of all, I'm changing my goddam pager number so that you won't be able to page me every 5 minutes, preventing me from EVER getting any of my shitty notes DONE.

BEEP BEEP BEEP
(calling nurses station)
"Hi it's Dr. X, I was paged?"
"Yes doctor, the patient has heartburn."
"ok did she respond to the PRN antacid?"
"I don't know, I haven't given it yet."
Wow, you took the time to look up my pager number and page me to let me know she's having heartburn rather than actually giving her heartburn medicine? Outstanding, soldier. OUTSTANDING.

5 min later

BEEP BEEP BEEP
(Calling back nursing station)
"Hi, it's Dr. X. Did you page?"
"Yes, doctor, you see patient's potashium today?"
"Ah, yes."
Pause "It was 3.9 doctor. You want to replete potashium?"
Ah, how about no, I don't want to replete the fucking potassium, because it's fucking NORMAL. Time to get back to my shitty progress note...now what was I thinking? Oh yes....

BEEP BEEP BEEP
(damning the nursing station to hell)
"It's Dr. X. You paged?"
"Just letting you know the new patient you admitted just arrived up to the floor."
"And?"
"Thats it."
Ok great. Don't forget to page me later if she blinks or farts or asks for an extra pillow!!!!!

It is at this point in the day that I start to think I hate my life. "Life" is really too strong of a word to describe my state right now. Can I just get one fucking progress note- BEEP BEEP BEEP BEEP

"Hi. You paged."
"Its the discharge planner. I'm a giant lazy turd of a human being and I'm a huuuuge bitch!"
She actually never says that but it's the gist of what I get out of all our interactions. "Yeah that's great dc planner. Ohhhh you want me to do MORE of your job for you? Sounds great. What else could I POSSIBLY be doing?

The ITI (see last blog) is running high today...maybe I can just finish...one...progress...note... BEEP BEEP BEEP BEEP

Well damn it all to hell. "Yeah, you paged?"
"Patient Z has been blowing her nose and blew her nose really hard and blood came out!!!"
"Is she having a nosebleed?"
"Well- no."
"So there's just blood in the mucus?"
"Yeah, but like, blood!!"
"Is it a lot of blood or a few streaks?"
"Well a few, I mean, it is bright red!"
"Yeah...so no nosebleed and a few streaks after she blew her nose hard. Ok. Well tell her try to blow her nose gently, page me if she gets a nosebleed."
"You want to order a CBC to check on the bleeding?"
Nope. You want to replace the battery in my pager for all the stupid shitty pages I've gotten from you guys all day? I got fewer pages on sicker patients working in the ICU. Fucking heme onc. I can't believe it's only day 4......of 28. :(