Every time I call a friend, all I have for them is more work. I’ve never yet called to say: “I hope you’re having a great day. Why don’t you take a break and have some fun? You’ve worked enough.”
Nope. I only call to give them extra work. Whether it’s 2 a.m. or 2 p.m., I need you to get away from your bed/lover/high horse and come take my patient. All, always, sick. The healthy ones I send home without waking you up.
Sometimes they’re not sick enough. My ortho friend says: “Are you crazy? Just because she has broken her wrists you think she needs to stay?”
“She walks with a walker. How’s she gonna walk? How’s she gonna wipe herself? How’s she gonna stay alive?”
He looks at me like I’ve lost it. He doesn’t do comfort or supportive care. The patients either need surgery or they don’t. It’s not rocket science. It’s not his problem. But then whose is it?
Sometimes they’re too sick. “Are your out of your mind? She’s 95, her systolic is 74, and you want me to admit her to the ICU? Call the hospitalist and make her comfort care.”
I’d be happy to, but it’s not my call. It’s hers. If she’s with it and she wants the intubation and the electricity and the broken ribs from CPR, in short, she wants everything done, it’s her choice. She’ll get everything done, at whatever cost to herself, to her family, to society as a whole. I’m not entitled to make decisions for her even if I think I know better, even if I wouldn’t make those same decisions for myself.
It gets even worse when it’s the family’s decision. Her daughter who left home at 22 and hasn’t seen her in 50 years; her ex, who eloped with the babysitter and is now so sorry that he wants everything done so he can confess — I mean apologize — and get it off his chest? They want it all, the rib-breaking CPR and the foley and the tubes, as many of them as her body can stand, and whatever other misery I can inflict on her as long as she gets to stay alive long enough for them to drop their load on her and be set free.
But I digress. I was talking about my friends, the ones I call when the going gets tough, and I need help.
I call my cardiologist. “I have this 90-year-old with an EF of 25 who comes complaining of fatigue. Her troponin is 7.”
“Why are you calling me?”
“I thought you were the cardiologist.”
“So what? There’s nothing I can do for her. She gets admitted every week for something. There’s nothing I can do for her, why call me?”
I get angry. Very angry.
“She’s got a long cardiac history, chest pain, an abnormal EKG and a troponin of 7.” I say it softly, as softly as the hissing long fuse of a detonation cord after it’s been lit.
“She always makes troponin. She’s got to have some arrhythmia; she always makes troponin when she’s got an arrhythmia. What’s her EKG like?”
“It’s sinus at 110. I see no arrhythmia. I can take a picture of it and send it to you.”
“No need. I can access her EKG.”
Maybe you should.
“I’ll see her, but I won’t admit her. Give her to the hospitalist.”
Of course. If there’s anybody on the totem pole lower than me, getting shat upon every day by every specialty known to man, it’s the hospitalist.
They are smart and hardworking and always there. They are the Cinderellas of medicine. Their ugly stepsisters piss on them whenever they get a chance. Not directly, no. Via me. I get to call them and get them to admit surgical patients and oncological patients and cardiology patients and any other patients. Soon enough I’ll call them to admit patients for the vet down the road. He’s a specialist too. “I have this 2-year old-lizard …”
I call the hospitalist. She has an accent. She came here legally to practice medicine, but the system didn’t allow her into the hot fields like dermatology, ENT or neurosurgery. She got to be a hospitalist in this after-life, whether she was a nephrologist in Peru, an endocrinologist in Romania, or an oncologist in Bulgaria.
She’s smarter than I am— she’s an internist. They think long and act slow. I’m an ER doc. I think fast and act now. I’m the cowboy while she’s the judge. The house of medicine needs us both.
“Why do you think this patient needs admission?”
“Well, she can’t walk,” I say, feeling like a fraud.
“Did you try walking her?”
“No. She walks with a walker and now she has two broken wrists.”
Or a hip. Or a pelvis. Or something else that’s gonna stop her from going home to her previously marginal function. I can’t send her home, and nobody else wants her.
“She’s all yours.”
Still wondering why I have no friends?
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