Let the music play

With people starting to come up to me at work telling me that they enjoy reading my blog, there's now this immense pressure to deliver that has become somewhat suffocating. Ideally, I'd like to discuss something interesting, insightful, or moving with each of my blog posts, but let's face it, sometimes there's just nothing to say. Or sometimes, screaming out into the ethos of the internet is just a form of personal catharsis with no edification to the reader... for which I apologize.

For example, the other night on call I had the most frustrating consult from the emergency department to date. It was a kid with a VP shunt that came in with nausea and vomiting. She ended up having an ear infection. Imaging of the brain revealed that the shunt was working just fine. But the ER attending felt it necessary to have neurosurgery consult and do a full evaluation on her, despite a known etiology for her nausea and vomiting (shunt failure can cause this too, but usually it's accompanied by radiographic evidence of failure on CT).

ER Resident: Can you please see this patient?
Me: What's the reason for consultation?
ER: She has a shunt...
Me: It's working just fine.
ER: She has a shunt... and nausea and vomiting.
Me: Are you kidding me? The CT shows that it's working, her ventricles are smaller. She has left ear pain, and nausea/vomiting from otitis media.
ER: I know, I know. I'm really sorry, but my attending wants neurosurgery to consult.
Me: She's feeling better. She actually wants to go home right now.
ER: He still wants you to consult...
Me: And what am I supposed to say in this consultation?
ER: That the shunt is working...?
Me: ...

GAH! Luckily the resident was nice and understanding of the unfortunate situation she was putting me in. It was my 8th consult that night, and there was a gentleman in the next bed over in the ER with a subdural hematoma that needed draining. You've got to be kidding me. I was reminded that we're not allowed to refuse consults. True, but I can make your lives miserable by not seeing the patient and having her sit in your ER until I'm done with all my other work.

I saw the patient promptly anyway. I didn't want her to suffer for the ... management decisions of this attending.


Today, post call I tried once again to do some reading for research. I just can't. The constant sleep deprivation and disturbed circadian rhythm has left me rather anhedonic, and possibly bordering a point of depression. Coming home to a quiet room and submersing myself in good music seems to help though. I tried hanging out with some friends this weekend to escape the lull of monotony and death/dying... but it just left me more tired the next day at work. Maybe I just need to get a bigger TV...