'How many patients is she covering?' I ask, a little annoyed.
'She's got this whole side of North.' the resident tells me.
'I mean we can split it in half, you take one half of her section and I'll take the other half, at least until Dr. [director of the ER] and Dr. [Chief Resident] finds a better solution.' I say reluctantly.
'Yea, I guess we have no choice.' the resident replies, knowing that her work load just increased by 50%, along with mine.
One of our second year residents just went home sick. While I don't blame her, she was deathly ill looking, the whole situation means more work for everyone else involved.
'You take 1-7, and I'll take 47-41 plus 6 & 8, at least until we can get something else worked out. No new patients in this section until it's figured out.' I say. Luckily for us most of the patients in this section have already been seen and are either pending discharge, test results, or minor procedures. One needs sutures and the other a spinal tap. Luckily neither of those are mine.
*I look at my computer screen.*
I see one new patient was just added to ER room North 41...name: LeBlanc, K. he's the last one.
I proceed to flag the other rooms in question as unavailable for new patients as the unit clerks starts phoning triage and ambulance reception to tell them of the temporary measure. By the way the conversation is going, neither sound too happy about it.
*Re-focusing my attention on my current case list I see that patient Dunne, A. has lab results ready to view. I open the lab results, and everything is as I expected*
White blood cell count 19,000, elevated lactate Urine leukocyte esterase is positive, White cell casts found on microscopy of urine. Electrolytes are more or less fine, but kidney function looks a tad decreased. No surprise there. 1+ hematuria.
I've seen enough to call it. This girl has classic pyelonephritis.
*I type up my assessment and complete my admission note*
Patient being admitted for sepsis secondary to acute pyelonephritis.
*The phone rings, and the clerk answers it*
'Dr. Said on the phone for you, Dr. Grant.' The clerk tells me.
*I pick up the phone*
'Hey Dr. Said it's Dr. Grant down in the ER. How are you doing?' I say trying to establish a good rapport before I ruin his day with another admission.
'What do you got for me?' he asks in a light arabic sounding accent. He wastes no time on pleasantries. Who was I to kid? A hospitalist is getting a call from the ER...he know's he's getting another admission.
'Hey so I have a 19 year old female, who came in by ambulance for altered level of consciousness...' I deliver my report, stating that I've started her on fluids and gentamicin and that she is stable. I then relay the lab findings.
'Yes, it's urosepsis and pylo. Alright, just continue what you have, and I'll take a look at the chart and see her when she gets up here.' he tells me.
He hangs up.
*I finish my note, and log out of the computer. I then proceed to the patient's room.*
*Walking into the room I knock on the door way*
'Hey there, so the results are back and it looks like she has a urinary tract infection that's progressed up to her kidney, causing sepsis.' I say.
'So I'm going to admit her to the general internal medicine ward. She's going to be seen by Dr. Said, one of our hospitalists and he's going to probably continue the antibiotics and monitor her condition until everything is resolved. We'll get her moved upstairs as soon as we get a bed assigned to us, but just from how things work around here, it can be up to an hour from now.' I say realistically.
*I pause for a moment before asking my standard line*
'Do you have any questions, or is there anything else I can do for you?'
With everything said and done, I shake Dunne's hand. I see that Aubrey is sleeping, so I forgo saying goodbye to her.
'She'll be taken good care of.' I say exit the room in reassurance.