Just... odd.
I didn't sleep well last night. Barely at all, really; I remember staring at the ceiling for hours, and then rolling over at 3 AM, and thinking, well, it's not time to get up yet. And I waited until 4:30, and sighed, and at 4:45 I went running.
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In the fast track we had five med students. Five! Usually we cap at two, which, depending on my mood, is one more than ideal. Not that I don't like the med students: We joke, we shoot the shit, sometimes I supervise, like, their abscesses or eye exams, and I feel important and they feel (I hope) less scrutinized than they might in front of the attending. Wins all around! But it's hard with three, impossible with five: With five, the six of us -- six! -- who all have to present to one attending basically line up, charts in hand (sometimes double-stacked), and the patients tap their feet and wait, wait, wait hours to be seen again. It's ridiculous.
Anyway. So today there were five med students.
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Which leads us into anecdote number one: One of the MS4s asked me how she might refer someone to psych as an outpatient. Huh, I said. I don't know, but let's go next-next door to the psych room and ask.
Of course, running the psych room today was not any of my psych resident friends -- as I was expecting, as has happened on more than one occasion -- but the short, inappropriately-shod, overly-perfumed, nasal Yankee of an EM attending, whom I believe I once called
DrSheilaBrovlovsky. So I walk over to the desk, and I ask, "How do we refer a patient to outpatient psych?" only *as* I am asking I reflexively move my forefinger to my temple to indicate "mental health," or, uh, "cuckoo."
Then -- not even mid-gesture, but before the attending has even noticed the gesture -- I catch myself and then undo it -- the catching, not the gesture -- by saying, aloud, "Oh, wow, that wasn't PC."
So she says, What?
And like an idiot, I explain that, Ha-ha, I reflexively made this gesture. This gesture which I will now make again, for your benefit, while you stare at me dead-eyed. And she gets Very Special Episode offended and starts talking about how we take mental health seriously in this institution. "Right, of course," I said with a smile, but she still had total pissed face. As they say on the net, FML.
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Later in the morning, or maybe I mean afternoon -- it all starts to look the same when you don't pee 'til eight hours into your shift -- when once again all the charts were picked up by the med students (what was I saying before? I love med students!), I decided to bounce on over to radiology to get the read on this ultrasound. Now, I've only worked nights at the hospital thus far, and that might also be part of the oddness of today: When you start out on nights, the days are too loud, too busy, too many people bouncing through on tours and repairs and everyone doing day-shift things.
Also, it's weird but you see more light working nights than you do working days. Because when I go jogging at 4:45 PM, it's light outside. And when I bike home at 7:30 AM, it's light outside, too. Not anymore.
Anyway. So it's day shift, and I bounce into the radiology suite, where only a few nights ago, it was just me and the weirdly flirty adorable Lebanese Christian (married, of course, to a Jewish woman, and her dad is his financial planner, and also, he loves Tel Aviv), shooting the shit. (He told me I had balls. I had to agree.)
And days in the radiology suite, there are actually two radiologists. And they're attendings. Attending radiologists! Shit! And the one I initially bother, who is instructing (sort of) two med students, directs me to the other, the one who reads ultrasounds. And neither one seems particularly bothered by the interruption.
(If you have ever worked at Healthyman, you know what a Thing It Is to bother radiology. Radiology is not to be bothered! EVER.)
And as the radiologist who is reading my ultrasound is flipping through the images, I hear, from over the barrier, phrases like, "he had a mistress, who used to be a prostitute," and also, "he was Elvis' lawyer." And while I try my best to pay attention to the dull black and white images on the screen before me, I can only be untrue to myself for so long, and so I edge the three stems down the room, and put my face around the doorway with a *look*, and I say, I am sorry, but this sounds like a very good story that I would like to hear.
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It seems that this radiologist, who grew up in Mississippi, made his way up to Staten Island, caddied for a while, until once he caddied for a famous woman who heard him talk and said, "Boy, where did you get that Oxford accent?" And he said, "Ma'am, you must mean Oxford, Mississippi," and thus he entered a famous Staten Island school, which was also, possibly, used to film part of the Godfather. Or it wasn't, and maybe the radiologist was talking about some other place on Staten Island. Also, he inherited some land out on Long Island, to which he has never been. Is it near where I used to live on Long Island? How should I know? Anyway, so this radiologist, at one point, lent some seed money to a group of fellows who wanted to invest in land on Beale Street, Memphis -- "I know that from
a country song," I said, and he smiled -- and before he did so, he hired a lawyer, who had, incidentally -- and he found this out much later -- gone to the same school he'd gone to, with the woman who had been his Staten Island patron. Maybe, possibly, it's all unclear now, and maybe I mean that one of the group of fellows who needed seed money went to school on Staten Island. At any rate, this lawyer, whose name was D Beecher Smith II, who once wrote Elvis' will, and his wife witnessed it -- Beecher's wife, not Elvis' -- anyway, he had a mistress by the name of Judy, who once was a prostitute. She's a schoolteacher now in Mississippi. "As so often happens," I added, but you should get the idea, by this point, that I am unnecessary to the storytelling that is happening here, and while I am glancing at my watch from time to time I am unwilling, at pain of death and job loss, to leave this dark room even well after twenty minutes are up, and fetching a radiology read should only take five. And rather than doing due diligence on these fellows, Beecher just asked Judy what she thought, because, being a former prostitute, she knew all the goings-on of the gentlemen about town, and when she told Beecher, Oh, they're fine, Beecher reported it thusly back to our radiologist. This is about 1988, 1990, and I only add in that detail, which I interrogated out of our storyteller, because he had mentioned that Beecher did not even do a UCC search on these fellows in Beale Street, and it seemed so ridiculous to me that this narrative, which otherwise could be a tale out of the forties, or the eighteen-forties, should contain this side line about a UCC search. Anyway, the long and short of it is, and this part, I missed, because I was listening to the quieter attending tell me something relevant to patient care, anyway, the long and short of it is, our radiologist lost his shirt, and is no longer speaking to the man who went to his school in Staten Island -- I believe it must be him -- since a death threat came from that man, but the long way round, from a man down in Daytona by the man of Irving Fisher (and I, being a not unstrange child of cowardice crossed with opportunity, did not ask whether this Irving Fisher was one of the tribe of Israel, though I am fairly certain that he was), nor is he speaking to Beecher Smith, who, incidentally, is in prison on charges of downloading child pornography. "The thing about child pornographers is," said our radiologist, "they're so sick, they can't shut up about it. He's going to die in prison. He got five years; another guy, same case, fourteen months. Beecher must have had the worst lawyer in the whole state." He paused. "But of course the moral of the story is that, when someone comes to you asking for seed money, you tell him, I will give you my expertise, I will give you my time, but I will not give you my money, or I will give you a little bit of my money, but in exchange for a cut." I'm not really sure how it went; it wasn't so stupid as all that, because it is here that I was able to quote, misquote, mangle and still draw a smile, that line from Guys and Dolls about how one of these days the spade from a brand-new deck of cards is going to jump up and squirt cider in your ear. And our radiologist turned to the med students and said, You ought to see Guys and Dolls.
That is not the whole story, not all of it, for I told a little tale of my own, the tale of my family's great migration down from Long Island to Georgia, and, since the radiologist seemed into such stories, our brief and negligible contacts with Men of Questionable Morals in that strange land of Long Island. But in the end I did shake his hand one more time, and walk out of the dark with a spring in my step, and I know that when I shared that last story my speech was slower, and I was weaving a tale, too, out of the details that I had, and I was a little proud that maybe, maybe I can compete with the occasional radiologist, whenever he walks -- or sits, or just drops words above office dividers in the dark -- into my life.
God bless the American South.
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The rest of the day was less odd, more irritation. We, the attending, bless her, and I -- and oh! it was a her! I have had so few hers as attendings, despite this program's being heavier in the XX than most -- had a patient whose last study revealed something, um, concerning enough for me to emote, "Wait, WHAT?" at the computer screen, and yet no one had called, no one had so much as mailed a damn letter, and so the patient sat in ignorance and turned up in our ER for something entirely unrelated. And so despite its not being our job, we figured, well, damn, someone ought to tell this person to follow up with these specialists, and of course the specialists were uniquely unhelpful with hints or scheduling, and meanwhile the ER clerk was just brilliant, and the radiology tech was brilliant, and, as I said, the ER attending was brilliant, and if it all turns out to be a big false alarm, fine, but at least we made the effort.
Incidentally, of course, this is why we don't order studies in the ER which won't be back by the time of the patient's discharge. This is why we are trained to be curious, but only so. How many studies would fall through the cracks? How many patients would have bombs, somewhere, hidden in their password-protected Os and 1s, and how many would have been realized too late to have been realized already?
I'm sorry, that radiologist made me purple. I'll get over it.
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At the end of the day it began to thunder, and when you can hear thunder inside the hospital you know it's extremely loud outside. My relief drifted in, soaked to halfway up her pants and hair all wet. "And I had an umbrella," she sighed, before she went off to find a replacement for her socks. (She settled on surgical booties.) After sign-out the ER residents went running -- literally, all of them, running -- to the ambulance ramp to hitch a ride on EMS, which was ferrying people, ten at a time in the back, to and from the parking garage.
(By wikipedia, the parking garage is a little over 700 feet from the emergency department lobby, and most of that distance can be traveled by covered pedestrian walkway. You know how, in Hong Kong, I wondered why these covered walkways existed, when the streets already have sidewalks? And at least one friend on facebook replied, Because covered walkways are extremely useful during monsoon season. Except that no! No they are not! At least not in New Orleans, where -- and I know this from experience -- the rain blows in sideways.)
I swiped a garbage bag from a nearby trashcan, smiling at the security guards as I did so ("Yes, hi, I am a highly paid professional, and I don't have a raincoat, and shut up."), and stood outside on the ramp, poking the necessary holes in the thing after the EMS schoolbus pulled away. (My fast track replacement had already told me that I would die biking home, and I didn't need more discouragement.) I felt better after an equally determined nurse -- his scrubs rolled up to his knees, plastic bags over his shoes -- strode out of the sliding doors. "Good luck," I said to him. "Eh," he said. "I'll just get wet."
So I walked over to my bike, and wiped the seat off as best I could, and as I was climbing on the MS4s passed, again. "Sure you don't want a ride?" one said. "Nah," I said. "I do stupid shit like this all the time."
Y'all. Y'all. I am pretty sure I have just written my own epitaph.
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And I got home, and the power went out, and by the time I was halfway up the block, hoping for the camaraderie of porch parties that happen when the lights go out, it flickered back on, though not without an impressive few sparks from one streetlight in particular. And so I walked around the block, and came back inside, and ate my dinner.
It is time for bed now. It was time for bed so, so long ago.
Dear New Orleans: Today was an odd day. And yet I should not expect anything else.