After a little over a week of night float I’m thankful to report that the first night was by far the worst night. The work load is really hit or miss, and I think it depends who is staffing the ER. Some attendings are seasoned walls and can feel comfortable managing a wide variety of things, and will let very few cases slip by and be admitted to the hospital. While others are sieves that tend to let the simplest of complaints warrant an overnight stay. The two major problems I’m starting to see at least at this military hospital is that a lot of staff are pretty young leading to less seasoned staff running the ER, which means more things slip through to get admitted. Second, there are no observation beds in the ER. Other hospitals tend to have a 24 hour observation section off the side of the ER for lower acuity patients. So more patients need to be admitted. In short, some nights the ER might be full and we won’t get a single call, other nights it may not seem that busy, but we are somehow admitting all night long.
One thing I am surprised about is the diversity of the patients. Before I started I thought this year would be pretty boring, I was thinking a military population wouldn’t really get sick. Turns out that I have been seeing a lot of the same things I would see in any other major city. The reason being is that it's not just active duty that come to the ER. Veterans, retirees, spouses, and children all get access to our gates. Granted its not quite New Orleans, we don’t tend to see the sweet old grandmas that upon further questioning enjoy their bump of cocaine before bed, and I tend to get funny looks when asking senior citizens about what kind of street drugs they use.
The other thing I enjoy is that in the middle of the night not only medicine can admit, but neuro, surgery, and heme/onc all have their own call teams. There is even a chest pain service, so in theory I don’t have to be up all night doing acute coronary syndrome rule outs, which was the vain of my existence at Tulane.
I’ve gotten a little more used to the flow, and the schedule of being nocturnal, which I really am now. For example I have a couple days off so yesterday I stayed up until 10am went to bed and woke up at 7pm. Now I’m sitting in IHOP because it's the best thing San Antonio can offer in the middle of the night. But, I have to say, being at IHOP on a Saturday night at 3am completely sober is pretty entertaining.
One thing that is coming into focus about this year is that there really is no room for error. I’m not talking about patient management, there is plenty of room for error with that. I mean day to day life. This came to light a few days ago as I started to get sick, probably nothing given the amount of viral stuff floating around. But, the thought occurred to me, what if I actually needed to go see someone, and then what if I needed to see a specialist after that.
Right now I get home from work around 10am and wake up around 5pm, and even though my hours will change my availability during the day won’t. My resident agreed that this is one of the hardest aspects of residency, he was telling me how he could barely get to the dentist during his intern year. God for bid the engine in my car falls apart or something. But my life is fairly simple. I’m not sure how having a wife and three kids works during this year, and I know plenty of people in that situation. Basically whenever I feel crunched for time I just think of how hard it must be for them.
My other new found pleasure in putting my own life into perspective is driving over to the basic training side of base and seeing the new wide eyed 19 year old basic trainees get yelled at. I fell into this by mistake the other day when I went over to the finance department. There was about 40 new BMTs (basic military trainees) lined up outside, they had just got off the bus and all of them were still wearing civilian clothes. Weaving amongst the flock were about 4 drill instructors. There was a lot of nonspecific yelling as I walked by. Some of things I caught were “You piece of shit! Look at you, you're a fucking disaster”, or “I should choke you out right now”. The best part was when I walked by the drill instructors they had to stop what they were doing to salute me and say “good morning sir”. So as tough as this year can be, at least I’m not a BMT. Hey that kind of rhymes, might be a good slogan.