Night shift #1

Well truly not as bad as I had thought. I only worked 4 hrs. And it was busy - but slow for me. I just stood around and ended up talking to the three patients my resident was caring for. There was one nurse assigned to those three - who was just almost frantic all the time, and had his preceptor nurse looking over him, correcting him, grilling him. My resident is a tall skinny latino guy with glasses. He was so busy and yet i have no idea what was so time consuming. i swear to you he was pacing around, making phone calls, writing stuff down on the papers, ordering the nurses around, breathing coffee breath down on me, and he kept on tell the patient, "sorry sir, i'm going to get to you soon." Craziest part is, there is a waiting list of 100 or more waiting to be seen. Some have been waiting for 12 hours for their turn to come in to one of the rooms and be seen. Depending on acuity they will be seen sooner or later. The guy that got in was an older man in his sixties with a rare condition acquired after a sting from a yellow-fish in the Alaskan waters where he worked as a fisherman. The venom caused him to get Endocarditis - this is extremely rare, and the last documentation of such an occurrence from this fish was in 1958. As a result this poor man has received three consecutive aortic valve replacements. The first was from a cow and somehow fell out, causing him to go into immedicate congestive heart failure. The second was porcine and somehow became ineffective over time and was replaced with a mosaic porcine valve. today this man was presenting with acute stabbing, squeezing pain at the precordium, radiating to his jaw and left shoulder and occurred during exertion, with diaphoresis, nausea. The pain was 8/10 and lasted for an hour until the paramedics arrived and gave him some aspirin. In the ED he was given nitro, serial EKGs, and troponins. The EKGs were negative for ST elevations (meaning no ST Elevation MI) but the Tn returned as .14. Nitro drip was started and teh cards team consulted - calling it Non ST elevation MI. The poor guy was homeless on his way to see his daughter here in LA. We took his boots off to look at his feet and feel his pulses - and boy did those feet stink! the room just reeked. pobrecito.
The other patient we had was not too interesting, latino guy with 9 days of watery diarrhea and three days of RLQ pain, here to rule out appendicitis. What was the most interesting was his phone conversation to his mom that I overheard. He called his mom and said, "Ama pues aqui estoy. todavia no me atiendan. Pero me toco un doctor chicano y una chicanita." Pretty awesome. Doesn't happen very often. He told me he thought the white doctors treated him worse, he said he felt like they didn't care, they would send him home with pain killers y ya. they never tried to figure out what was really wrong with him.
ANyways, most of my night was spent chopping it up with these two guys. About life, diarrhea, and fishing in Alaska.