I’m getting off the track here because I’m a little tired. Anyway, so I brought her up to the floor and got the IV in and did the whole workup, and by two o’clock everything was done except a urinalysis. I spent most of the rest of the night chasing after her with a urine cup, trying to get some of her precious body fluid. Yes, my mother sure would have been proud of me!
They hadn’t been able to get any urine from her in the ER. I didn’t want to start her on antibiotics until we had a sample of urine because she had had a UTI [urinary tract infection] in the past, and if she had one again, we needed to know about it. I wasn’t having trouble getting the urine because she wasn’t peeing; it was that she wasn’t real happy about peeing into any kind of container. Right after we got her up to the floor, she was standing on the scale in the treatment room and she let loose a stream, so I ran over with a cup just in time for her to pee all over my hands. No urine ended up in the cup, of course. Then we decided to straight-cath her [place a sterile catheter through her urethra and into her bladder in hopes of obtaining clean urine], but just as soon as I got close to her with the catheter, she started to pee straight up into the air. I managed to catch some of that in a cup, and I ran off to the lab to analyze it. It turned out that her urine was clean as a whistle. By that point it was about five in the morning. I got a total of two hours of sleep.
I found out later she was a patient I had taken care of in August on Infants’. Now she’s graduated to Children’s. These kids keep following me all over the place. Next thing you know, Hanson’ll show up again. Hanson! Now, there’s someone I haven’t thought about in a while! You know, no one’s heard anything about him since I discharged him from Jonas Bronck in October. But I know he’ll turn up again, you can be sure of it. It’ll be the busiest night of the year; there’ll be hundreds of admissions to take care of, and he’ll come toddling in and take one look at me and crump right there and then!
I’ve been totally and completely terrified of Alan Morris [the attending in charge]. Monday, on the first attending rounds of the month, he asked me to tell him about my patients. I went to present my first kid and I started off by saying, “This is a six-month-year-old-month old . . .” I just couldn’t get the words to come out right. I got so tongue-tied I finally said, “Forget it! I can’t present anybody to you! You make me too damn nervous!” That was good because it loosened everybody up. Alan seems to make a lot of people uptight. I’m not sure what it is about him that does it. Maybe it’s the whip he brings to rounds with him. Or the buzzards who are always circling over his head. I don’t know why, but he definitely makes me uptight. He’s a great teacher, though; so far, rounds have been excellent. I had to present my sickler to him this morning and I managed to get the words out, but I was still nervous. Then we wound up talking about sickle-cell disease and he happened to hit on the one area I actually knew something about. He grilled me for about a half hour and I think I did a pretty good job. In fact, he must know I need some positive reinforcement, because for the first time since I’ve been here, I actually heard him give someone—in this case, me—a compliment. He said something like, “I don’t care what everybody else is saying about you, I think you’re doing a reasonably good job.” Talk about a vote of confidence! I guess it’s better than having him say he thought I was a complete idiot!
The floor was a real disaster today; poor Ron was getting creamed! There were four admissions, and each one had a bizarre story. One of them was an eight-year-old with subaortic stenosis [an obstruction to the flow of blood below the aortic valve; this obstruction prevents blood from getting from the left ventricle of the heart out to the rest of the body] who was only mildly symptomatic but who was admitted for surgery anyway. Ron and Amy, our resident, did a complete workup, history, physical, labs, the works. When they had drawn his type and hold [a specimen of blood to be sent to the blood bank so that blood for transfusion could be prepared], the mother said, “What are you doing that for?” Martha told her it was for the blood bank and the mother said, “Well, you don’t have to send it. Don’t you know we’re Jehovah’s Witnesses? There’s no way you’re going to give my child any blood, and that’s final!”
They went crazy. Ron was ready to reach into the cardiologist’s mouth and tear out his vocal cords. And then this whole big thing started with the cardiothoracic surgeon, two or three anesthesiology attendings, the cardiologist, and us. The Anesthesia Department refused to do the surgery without the option of using blood if it was needed. They had to call the hospital lawyers and wait for a ruling. The whole thing took hours, and the end result was that the kid wound up going home. Amy and Ron were pissed off, the cardiologist was pissed off, the CT surgeon was pissed off, and the anesthesiology people weren’t exactly happy.