Post Turkey Tryptophan Toxicity

The Journal of a Gypsy Doctor

Yesterday I came back from my first 9 day vacation away from the emergency department. It was turkey day, so my tryptophan levels must have been sky high.

I wasn't the only one with toxicity... My patient with digoxin toxicity: " Can you please gag the patient in the next gurney?"... Me: Gee, Attending, I think she might be a little altered, she wanted to gag the patient in the next bed... Attending... Maybe that's her baseline, maybe she's just cantankerous?

I guess I forgot how to be mean on my vacation, when I came back
yesterday, I was just like "oh you are standing in the emergency room
looking lost and you want to use the phone to call your cousin from
vermont? oh sure I can help you with that".... or.... " hi I am the
clueless surgery consult from upstairs and I can't find patient
booboohead can you show me where they are?, no problem, here they are,
let me drop what I am doing and log in to this computer terminal and
show you." Or the patient handing me a bottle of urine in the middle
of the chart writing area and smiling..grrr. several choice statements
and comebacks left my vocabulary for the past week... I felt aphasic,
I couldn't even name the peak flow meter to the nurse, I went looking
in the drawer for the puffer thing the patients blow into...I spent half my shift happily chatting to people instead of doing what I was supposed to do as an intern.... which is writing my notes, pushing paper, slipping x rays, calling primary doctors, calling the lab, waiting on hold.

I am arming myself with these for tonight... there is a public
telephone in the lobby... or... did you ask the charge nurse? did you
ask the consulting resident where the patient was? or... when you are
done with the urine, please hold on to it until I return...or.... this
is a chart writing area, although this counter looks like a desk in a
hotel lobby I am not your concierge nor will I be leaving a mint under
your pillow... or...in a more monty pythonesque vein (you have to see this movie to really understand this one) think of this counter more as a castle wall from
which I fart in your general direction.

I love the ploy where the ambulance brings in an unresponsive patient
and the third year resident says... ok, John do you want to
take this one, it will be a good experience for you, not quite a
stroke code but not much to do, just a bunch of stuff to get
cooking....Gee, I am kind of swamped... Oh we all are... we need
a stat CT Head, C spine, Portable chest, ABG, you need to talk to the
family, get those labs, check those labs, fill out that paper for the
CT, write the chart, consult the CCU and the MICU, and don't forget
about the other six patients you have.

Then there is attending number 1... Make sure you call that private attending and
discuss whether this man who walked here needs a stat MRI tonight or
whether he can wait till tomorrow. Why hasn't the radiologist called
back with the report? Radiologist.... Yes Call the sono lab, they are
reading the reports there. Lab... the patient is on the table still
getting the study which was ordered four hours ago... Sir, I am
sorrry, the report is not available because the patient is still
getting the study.
Then Attending number 2... I thought that patient was ready to go when
Attending number 1 signed out to me! I thought everything had been
arranged! Why is this patient still here?

Me. 10:30 pm, 14.5 hours after my shift began. Why am I still here?