Portal de Periódicos da CAPES

Same Shift, Different Day

2022; Lippincott Williams & Wilkins; Volume: 44; Issue: 9 Linguagem: Inglês

10.1097/01.eem.0000874716.33650.73

1552-3624

Stacy Harmon,

Figure: consultant, humor in medicineFigureHe hung up on me. I called him back, and he said, “You kept me waiting for a minute and a half.” The rest of the conversation didn't go that well. He was a surgeon who had accepted a patient in transfer, one that had been arranged by a colleague and signed out to me at shift change. I was calling him because the hospital where he wanted to send the patient had no beds, but another one where the surgeon also had privileges did. I wanted to make sure it was OK for the patient to go there, but I made the mistake of seeing other patients instead of sitting by the phone. I know; what was I thinking? Forrest Gump said life is like a box of chocolates, and I think consultants are too: “You never know what you're gonna get.” It Takes All Kinds See's Candies was the Cadillac of candy when I was a kid. It was a high-end Mother's Day and Christmas gift, a special-occasion candy. My challenge was what Forrest articulated so well. The crunchy toffee ones were easy to identify and became my go-to. I did what you probably did to figure out the rest: I stuck my finger in the bottom, and if some cherry cordial or nougat goo that I didn't like leaked out, I just put that chocolate back in the box. I was convinced no one noticed because the top was unscathed. My analogy for figuring out the chocolates breaks down here, but I'm sure you have had some unsavory goo come from a consultant. We certainly know who is reasonable and who is demanding. One just wants the facts and then cuts you off. Another remains silent, lets you talk for an eternity, and then asks you to add something to the workup that has nothing to do with the admission. Some respond immediately, and others require multiple calls. Some are like the go-to crispy toffee: They ask about your family and never push back. Others are guaranteed to push back. My partner calls them two-call consultants. He likes to make the first call early to get the rejection out of the way, then he makes the second call after the workup is done. Some delay and drag their feet long enough for the patient to go to the next shift. Some patients are given to the resident, and then the resident asks you to repeat the story you just told the attending. Some argue about every step, but always agree to admit anyway. It's like the movie “Groundhog Day.” Don't you remember me? We have been chatting about patients for a decade now. You would think that some kind of pattern might be apparent—I actually do know who needs to be admitted. Chances are that you have asked the clerk who is up next for admission and then delayed a bit to get the next one in the rotation. You knew how unsavory your encounter would have been. You put that one back in the box and hoped nobody noticed. In Their Shoes It's funny how the time of day changes what patients need. Telepathy must be stronger after dark while lying in bed. Asking someone to come in to see a patient at night results in superpowers not present during the day. My hospital thankfully has two neurosurgeon unicorns on staff; they don't fit the stereotype at all. They are cordial, down to earth, and extremely helpful and responsive. They are willing to come in day or night, always easy to get along with and pleasant. I have to admit that it must be hard to be sweet all the time. It's bad news whenever the ED phone number shows up on your cell phone or pager. It is you or me asking them to do something. It's disposition to us and work to them. It's a train wreck or late hit, and it means staying over sometimes. I try to remember that one of the reasons I went into emergency medicine was to get rid of my pager because I didn't want to take that call. Granted, our shifts rarely end on time, but at least no one calls us at home. Most of our consultants are actually reasonable and easy to work with, especially when you get to know them and learn what they want. Some hospitalists even come down and ask if they can get started on any admissions that are in the works. One does his own central lines and once intubated a patient in the ED. That type of help from a consultant is like getting Willy Wonka's golden ticket. I'm sure they have plenty to say about us, in all fairness. I don't know about you, but sometimes my story just doesn't flow that well. Sometimes I finish a call and think, “That was some incoherent babbling.” I felt like a medical student back in the operating room cutting sutures. (You can only do it two ways: too short or too long.) I have on occasion even talked myself out of admitting a patient while talking to a hospitalist. I'm not sure whether they hang up and think, “That was refreshing” or “That guy's an idiot.” I don't think I want to know. So, they put up with us, we put up with them, and somehow, we care for our patients. We all might be like a box of chocolates or maybe a can of mixed nuts: slightly roasted, a little crispy, and very salty. Dr. Harmonis an emergency physician at Marian Region Medical Center in Santa Maria, CA. Read his past columns athttp://bit.ly/EMN-SameShift.