#37 / #38: Sayonara neurosurgery suckas

The last two call nights for neurosurgery weren't too bad although I am still frustrated with the whole experience of working my butt off for senior residents who don't care at all about anything else but whether I discsharge patients from the service or not. They don't even go into the rooms of the patients. They don't care about the patients.

Case in point: On one of the last nights on the service I was taking care of a patient who was on our service because he had metastatic cancer to his spine and we had taken a biopsy of the mass. The patient was a fifty-something year old self professed "country boy" - a former mechanic who now weighed 90+ pounds and was wasting away from his disease. The patient had been on our service for at least three weeks because we just couldn't find a nursing home that would take care of the patient. I had a good relationship with the patient and his family because when he first came into the hospital he had been somewhat demanding and I spent an evening calming him down and in the end we ended up having a joking relationship... In any case, over the previous two days the patient had been very sleepy on morning rounds but in the afternnoon he started having trouble breathing. I worked him up with a blood gas and a chest x-ray. The gas showed that there was something wrong with his breathing and when we pulled up his chest xray it showed a completely white left lung showing a likely effusion (fluid between the lung and the ribcage.) What this meant was that his cancer had likely spread to his lungs. I told my senior resident and he told me this:

"Go up the patient's room and call a medicine consult. If the medicine consult won't see the patient then call a code so someone else (besides me) will take care of the patient."

What was I supposed to do? I called the medicine consult and without threatening the above I got the medicine resident come help me take care of the patient. We were going to do a thoracentesis (drain the fluid off the outside of the lung) but then I realized that we shouldn't do that up on the floor during change of nursing shift (and the night shift on this floor is essentially like having no nursing care at all) so I suggested we transfer the patient to the stepdown unit first. The medicine resident decided to transfer the patient to the oncology service, which was the appropriate thing to do. We (neurosurgeons) should not be taking care of end-of-life oncology patients, but the next thing that happened was really upsetting. The medicine resident called my senior resident to discuss the care of my patient and my senior resident was really insulting towards the medicine resident and said that medicine had to take the patient and if they didn't, the neurosurgery service "would neglect the patient." I don't understand why this had to happen. Medicine had already decided to take the patient and there was no need to make them feel like chumps about it.

The medicine consult resident ended up staying late after she was supposed to go home so I decided to stay late as well. Our patient was clearly out of it mentally at this point so we ended up talking to his sister. Reading the above story it may be obvious that the patient was nearing the end of his disease course, but when we started talking about this fact to his sister she said that no one had ever talked to her about the fact that her brother was nearing the end of his life and she started crying. We spent a lot of time with the sister and talking about what would happen next.

The next morning none of the neurosurgeons even noticed that the patient was off of our rounding census and no one asked me what happened to him.

Later the next day I stopped by my patient's room and they had decided to stop all medicines and let the patient go home to spend time with his family at the end of his life. His whole family was in the room and the patient was delirious - thinking he was still in his garage. I said goodbye to him and spoke to the family outside his room. They were upset about the fact that their relative was delirious and dying but had dealt with similar situations with other family members recently and therefore were coping well. They were reminiscing about their relative and told me the following story:

My patient, the self-professed "country boy" mechanic used to own his own garage. He drove a golden colored Corvette and used to chauffer his pet white poodle around in it. He'd always leave the poodle in the car when he went out to dinner with friends and he'd bring a doggy bag back to the car and feed his dog while tearing it up down the road. It was such a nice image, and I thanked the family for sharing it and wished them luck as I headed out of the hospital for the evening.

Last call night Saturday November 25th and Wednesday November 29th.
Amount of sleep I don't remember.
Currently reading: Heat. A novel about a writer who works in Mario Batali's restaurant (aka Multi-Mario)
Currently watching: Monday Night Football on HDTV. I made the splurge and it's great.
Next call night: Saturday December 2nd after switching to Trauma Surgery.