friday afternoons...

They told us in school that friday at 4:30 the shit would hit the fan. It's when all the patients wanted/needed something and the clinicians would be trying to go home, go to their weekends, to no avail. We all laughed at the stories, after all they were just stories.

This morning was a smooth morning, 5 patients in all and it seemed that only 2 were new and pretty low maintenance. At a morning break I jawed with another new PA and we talked about things felt calm and we would be leaving on time today, yeah baby. Yeah well, it was friday, and around 3 or so, things started to stir. It felt ok at first, after all, I'd seen all my patients and now it was just a matter of follow-up and management until 4:30 rolled around. And as the minutes ticked by, and 4:30 loomed larger, the winds of fortune were gathering speed and about to whip my ass. The woman who was supposed to be discharged yesterday, but sweet talked her way into one more night away from her job and bustling house, was constantly asking her nurse for a letter stating her hospital stay - a small task. The woman who were worried had a PE was itching to go home and with the negative V/Q scan, that seemed just fine, except her coumadin level was still subtheraputic, she has a history of PE's and she still wants to go home and shower and change, not stay and let us bring up her levels - she was threatening to leave. Hell, I would too, cuz the shit was starting to stir. The man who had been ready to be discharged for days and days, sitting in our bed instead of his bed, was baseline bewildered beside his wife who had lied about her insurance coverage and now cried innocence when the care he would require cost near $700 a month (from a company she continuously failed to pay and now wanted more services) and passively blamed everyone for her inability to take her poor husband home. "Put him in hospice???? That's how he got the bedsores that brought him here!!!" They were deep and ugly and even I winced upon seeing them today. How can they pay for him to be in a hospice, but not some simple care in his own home with me??? She chewed the ear off anyone who would listen, and I was her husbands PA. The gentleman I had seen very early this morning, who probably had some aspiration pnuemonia required some consults and getting consults on a friday is tough business. But I'd started early, I knew better, even as green as I am. Still, the doc showed up right aroun 4:30 while I was trying to put out the biggest fire yet, and she had a whole slew of orders. Who cares that I'm done now, I'm still here and I'm his PA. All new orders, changes to others, customs orders, things I'd yet to do. And the creme de la creme, poor Mr C who's son was getting married tomorrow. He lives in Puerto Rico but he used to live here. He went for a check up while in the states, after all he had his heart valve replaced here. The doc found him anemic and decided to work him up as an inpatient. Don't worry, we'll have you out by friday - the wedding saturday, the flight home monday. We assured him once he was back from his colonoscopy, if all went well, he'd eat one meal and then be discharged. But here was one of the cardiologists on the phone, incredulously in disbelief that we would even consider sending him home today without anticoagulating him for 4 or 5 more days - after all, he has a mechanical valve and has been off heparin all day! What were we thinking???? I go to break the news to Mr C after explaining and advocating for him to the cardiologist. His jaw hits the floor and then sets tight in anger. He's been here all week and we're gonna tell him this now??? Even I was with him yesterday and told him all about how he'd be going home afer his scope - it's what the senior PA told me. Fuck, fuckity, fuck and fer fucks sake. We got the cardiologist on the phone directly with Mr C, his wife shows, they both do their best to be cool, but the floors been taken out from under them. It's now 5:15 and I'm not going anywhere soon. It's friday.