• Not too busy
• I got to sleep
• I still got a pretty cool patient

What more could a guy want? I mean hell - I got 3 hours of sleep last night. I'm not even tired now. Of course, who knows what happens when I sit down for a while after I eat --> COMA

About my patient (I've decided I'm going to start posting some stuff about them w/o identifiers so I don't break any HIPAA/Confidentiality laws):

He is 77 years old. He came in to the ED yesterday morning after 3 weeks of progressively worsening dizziness with occasional syncope (which has the longest freaking differential list ever). What finally brought him in was that he had a bad episode while cooking, became dyspneic and passed out in the kitchen for like 5 minutes. He denies any seizure activity, incontinence, post-ictal state, chest pain, headache. So here I am, I'm talking to this guy (who looks pretty healthy aside from some bad teeth.. more on that later) and trying to figure out what is wrong with him.

Now I have to go on my soap box.

If ever you are going to be admitted into the hospital, don't come to this hospital. The ED staff are idiots - at least when it comes to getting patients ready for admission. For example - I admitted a lady on my first call with H&H of 4.4/17. Obviously she's bleeding from somewhere, but the ED did not do a stool guiac. WTF? Another patient was admitted with a GI bleed, no stool guiac - WTF again? How do you diagnose someone with a GI bleed w/o a guiac? Can it even be done? My point is, if you have someone with a test that is begging to be done (like a CT Head in someone with syncope), please do it so I don't have to.

I'm off my soapbox now. And I ordered a CT head w/o contrast.

As I'm talking to this fellow, it turns out he has pretty extensive cardiac history (but no cardiac enzymes in the ED - another WTF?) and has had an MI and 4 way bypass grafts. He's also had 2 strokes (but with very little residual effects beside a slight problem with cerebellar function and some weakness on the right - 4/5) and has chewed/smoked cigars for 60 years. His teeth are so brown and ground down I was surprised to see any teeth left.

Anyway, he's a really nice guy though and he's been admitted for 23 hour observation which will probably be changed to a full admission before it's over. He's getting a CT head and carotid doppler. His EKG was relatively normal and chest xray showed some increased density on the left lower lung field, but nothing that really declared itself. We're thinking about a Holter monitor for 24 hours to see if maybe he's having any arrhythmias that are causing this syncope.

Ok, so the morning came and I saw all my other patients and went to rounds at 0700 (which would be ungodly early except that I was already at the hospital and dressed, so I didn't have to wake up too damn early - 0600). Actually was able to stay awake during post-call rounds - I was impressed. Usually I'm dropping off before 20 minutes have passed. I'm sure it doesn't look good, but I can't help myself. I don't think I'm gone for long, just nod and wake up again. We finished table rounds and were free to go finish our scut and then go home.. so here I am. Since I can't write orders or anything, it makes my life easier than not.

So, I think this afternoon we're going to have lunch with Ashleigh's parents. They're having hamburgers and all the dressings. This will be the first time I've not eaten something just thrown together in like 2 weeks. Home cookin' - ain't it great?

more to come...

¶ 9:25 AM