Christmas Day. It was my second hospital today with the second emergent admission for the second patient who skipped dialysis this week. Patient #1 was short of breath, chest pain. Patient #2's potassium is 7.9 and he has EKG changes.
Big fat duh to both.
As I am not a Christian, it wasn't my holiday and I don't actually mind working it. I do every year. Almost everybody is grumpy today because most people want this day off. (Kudos to my nephrologist for his grace under THREE attempts to go home only to have callbacks to the ER for the same exact stuff.)
Christians believe they are rewarded for taking care of people who refuse to take care of themselves. That reward is in heaven. I'm not going to heaven. Sounds nice and all, but I'm a lazy buddhist. My reward is ...breathing now. And typically, a paycheck. Nice and fine, but you can't take it with you and it's spent by mid-month on bills, anyway.
The point is that taking care of people who expect me to clean up after them is exhausting. I'm struggling today with finding my buddha-heart of compassion.
I am struggling not to say DUH! at the top of my lungs. I am biting my tongue from saying What Did You Think Was Going To Happen, Exactly? I am struggling with, If You Were Trying To Die Over Christmas (And You Might Have Been), You Don't Go To The ER When The Symptoms Start....You Sleep Through It.
I didn't get that guy who developed diabetes at age 3 today, or who was born with congenital polycystic kidneys. I got fat bastards who wanted to drink and eat and be merry all week and held off on following their physicians' advice until after Christmas dinner was over....and THEN made it my (and said graceful nephrologist's) job to fix them.
ESRD patients are all Medicare, did you know that? You and I pay for every last one of my patients. Some days I wish they would meet us half way.
Thursday, December 25, 2008
Wednesday, December 3, 2008
This is a public service anouncement
If you're going to attempt suicide, at least don't be stupid about it. Here's a tip:
DRINKING ANTIFREEZE IS STUPID!
Chances are excellent you'll wind up doing something stupid. For example, you might sit in the corner of your bedroom and rock back and forth and giggle. Your family might notice this is strange and before you actually die or respiratory failure (which, just so you know, TAKES A WHILE after you drink the antifreeze), they might call 911. EMS will get you to the hospital just in time to jam a tube down your throat to ensure your continued survival.
Or you might become addled and fall down your stairs and quite possibly THIS won't make you die. It won't even make you brain injured. But it will make your nose crooked and put scars all over your face so that EVERYBODY you see henceforth will ask you: "What happened to you?". This will likely make you very uncomfortable and might not nearly have the musical swell and soft focus you were envisioning.
The EMTs, the nurses, the doctors who bring you back from said suicide attempt (because you did not have a DNR) will not ask questions about your suicide attempt in a hushed tone of voice. We use normal tones of voice. It's the holidays and we have heard this story. We just stopped you from dying. Sorry, that's our job. If you'd chosen an alternate method, we might have not had such an easy time of saving you.
I'm not saying your life doesn't suck. Not at all. I'm saying your life is not the only one that sucks. It's the holidays. Get in line.
I find it interesting that the two ethylene glycol ingestion cases I've had just this week were not done in the "city" hospitals in our area, they were done in the Four Seasons Hospital in Cul-De-Sac Haven of Affluence, Colorado and the Hospital Hilton of Gated Community, Colorado. I'm not implying that money = less depressed or has less cause for depression. I would like to make the point, though, that if my patients had been further down the socioeconomic bracket, at least I could argue that they might have had less access to Google, PubMed and Wikipedia.
Fortunately or unfortunately for my depressed patients, ethylene glycol (like most alcohol-esque substances) dialyzes out very quickly. It might cause permanent damage to say, your kidneys, and now you're an end stage renal patient dependent on dialysis for the rest of your life.
And you thought you were depressed before.
I mean: GOOGLE IT, PEOPLE!
Duh.
DRINKING ANTIFREEZE IS STUPID!
Chances are excellent you'll wind up doing something stupid. For example, you might sit in the corner of your bedroom and rock back and forth and giggle. Your family might notice this is strange and before you actually die or respiratory failure (which, just so you know, TAKES A WHILE after you drink the antifreeze), they might call 911. EMS will get you to the hospital just in time to jam a tube down your throat to ensure your continued survival.
Or you might become addled and fall down your stairs and quite possibly THIS won't make you die. It won't even make you brain injured. But it will make your nose crooked and put scars all over your face so that EVERYBODY you see henceforth will ask you: "What happened to you?". This will likely make you very uncomfortable and might not nearly have the musical swell and soft focus you were envisioning.
The EMTs, the nurses, the doctors who bring you back from said suicide attempt (because you did not have a DNR) will not ask questions about your suicide attempt in a hushed tone of voice. We use normal tones of voice. It's the holidays and we have heard this story. We just stopped you from dying. Sorry, that's our job. If you'd chosen an alternate method, we might have not had such an easy time of saving you.
I'm not saying your life doesn't suck. Not at all. I'm saying your life is not the only one that sucks. It's the holidays. Get in line.
I find it interesting that the two ethylene glycol ingestion cases I've had just this week were not done in the "city" hospitals in our area, they were done in the Four Seasons Hospital in Cul-De-Sac Haven of Affluence, Colorado and the Hospital Hilton of Gated Community, Colorado. I'm not implying that money = less depressed or has less cause for depression. I would like to make the point, though, that if my patients had been further down the socioeconomic bracket, at least I could argue that they might have had less access to Google, PubMed and Wikipedia.
Fortunately or unfortunately for my depressed patients, ethylene glycol (like most alcohol-esque substances) dialyzes out very quickly. It might cause permanent damage to say, your kidneys, and now you're an end stage renal patient dependent on dialysis for the rest of your life.
And you thought you were depressed before.
I mean: GOOGLE IT, PEOPLE!
Duh.
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