Day three

at the new service.

Life's kind of okay.

Feet are hurting but rounds were still done at a somewhat-reasonable 6:30pm despite the attending having been in clinic again today.

The morning started slowly, after the transplant meeting at 7:30am. Yesterday I was told it would start on time, so I arrived at 7:30 sharp and naturally, I was the first one in the conference room. "On time" my behind. But they did start at 7:40. I'm not sure why I "had" to be there - I mean it was nice to see CT (cardiothoracic) surgeons are the same kind of narcissistic studs they are back in Munich. But I can't say I learned a whole lot or had anything to contribute to the mostly organizational meeting.

Anyway, after the meeting my current fellow, let's call her Jess from now on, told me that I was actually free to do what I wanted. Wow, that's new. She said I could follow up on whichever patient I wanted, she would want to teach me a thing or two about heart failure around 11:30 and there was going to be a conference on door-to-balloon-time at noon (that is in addition to the M&M meeting at the same time). Cool stuff. I could also follow the attending to clinic if I wanted but the resident was already doing that today. So I declined .. for one thing I didn't want to double-team looking over his shoulder all day plus then Jess would have no one to see new consults - should they actually come in. Which today, they would.

But first things first, around 8:30 I went up to A700 for the nice, usual Thursday ample warm cholesterol-packed breakfast. Yum. And guess who I found already sitting at a table there .. three Germans. During the course of the morning, we came and went but we still maintained a strong German presence in that room most of the time. I would have had to start getting smart about the first thing about heart failure but hey, I'm lazy and I'll prefer conversation over studying any time. So that's what I did for the following hour and a half, until morning report at 10. After a somewhat-interesting but not terribly new lecture on rhabdo I went to look at my young lawyer with the questionable sarcoidosis in his heart before going to see Jess.

As I have getting used to with my fellows, she was getting paged every five minutes while handing me and orally summarizing a few more papers. I'm not sure whether she expects me to read all this stuff any time soon or in my life, for that matter. She gave me six papers yesterday, three more today, which is in addition to the three I got from Carolin - all of these on heart failure - not even counting all the stuff from uptodate I printed on sarcoidosis (half of which I actually have read). I'm afraid this may very well turn out to be a sad waste of trees.

But interestingly, she also had two new consults. I actually had to ask whether I should see one of them and the answer was "sure, if you like". If I like? Really cool stuff. Sure I "liked" .. but then I had to choose which one. One was 77, with amyloid cardiomyopathy requiring pressors that the primary team now has trouble weaning off. The other one was 22 (!) with chest pain. Why would he be on the heart failure service? Well, because his dad knows someone that knows our attending. And as we know, our attending is good.

So I had to pick between 77-year-old guy with amyloidosis and 22-year-old with chest pain. Considering my past karma with everything I touch turning into case reports (if the biopsy's positive for sarcoidosis, we're actually going to write one) I just couldn't be responsible for this 22-year-old turning out to have some rare deadly disease. So I took the 77-year-old.

Before that though, I went up to A700 for some pizza and juicy M&M. M&Ms are usually packed, and so it was today, even though Borat was the only German I saw there. But I guess it was better that way, the place was packed despite the fact that they took out the room separator with some residents actually having to stand in the back.

After the M&M meeting, I went to see my patient. While working him up using chart and computer in the nursing station actually Jen came by. We had a nice chat, wallowing in memories of the good times we had together after having been separated for less than a week and of course making fun of the ridiculously long rounding times I was suffering from with my current attending. And following CS's suggestion, I did belatedly take her up on her offer to write an evaluation for me. Who knows, I might consider a career with the pill-pushers after all.

I just don't know anymore.

Anyway, quite a while later, at precisely 2:59pm, Jess paged me that we were "apparently" starting rounds in the ICU "now". I was at that time still extensively chatting with my new patient and his wife (attending's exuberant bedside manner already rubbing off), rushed through the exam at that point and met the team in the ICU. The attending was still discussing (what else) stuff with the ICU team, since he double-staffed as their attending as well. Meanwhile Jess was sitting at one of the computers there frantically looking up stuff on patients. She said our attending had just "dropped three more consults on her". That's not a nice thing to do minutes before rounds.

I asked her whether I could help her in any way and she declined. But having a hunch about rounds taking a while again today I sneaked out while the attending was talking to another family on the ICU down to the gift shop to get supplies (i.e. water and candy) to better make it through the rest of the day. I asked Jess and the resident whether they wanted anything and only the Indian guy accepted. I bought more though which Jess would later be grateful for after we had gone to cath the sarcoidosis suspect in the middle of rounds and her blood sugar was running low as well.

Anyway, I'll spare you the details about rounds and I'll get myself back home before it's dark again. Have been blogging for 40 minutes again. I guess I'm addicted. Will go into rehab back in good old Germany.

Oh by the way, the team is determined to take me to a karaoke place next Thursday. I'll be sure to vocally make them regret that.

Blog to you later.