Internal medicine wards

Ahhh, medicine wards, aka the floor. Where things always go....so.....slowly. I learned a lot this month, some of which will be useful in the ER, some of which will not. I did spend many, many hours walking through the hospital. And many, many hours on the phone with social work. I did have a few exciting moments, such as the Code Blue announcements that I ran to and during which I (occasionally) intubated patients in trouble.

I have the utmost respect for social workers -- in part because I'm absolutely terrible at the sort of things they work on. And despite the 75 hours/week I worked in the hospital, it seemed like I spent 15 hours seeing patients, 20 hours rounding, and 39 of the remaining 40 hours working on social work and discharge paperwork.

I had a patient this month who had been in the hospital for 6 months. But by the time I saw her, she wasn't sick. She was actually my favorite patient -- every day we'd spend a few minutes talking about her medical condition (a few aches and pains), her background (Broadway performer during and just after WWII), her daily breakfast (bacon was always overcooked), and the hospital-provided socks (not as warm as she'd like).

She had been admitted for a basic problem that only needed 2-3 days of treatment, but the neuropsychiatry team determined that she wasn't safe to go home by herself due to dementia. Her doctors contacted the social workers and case managers to get in touch with family members about having her placed in a nursing home of some sort. 2 weeks passed.

Oh, except she doesn't have any family members we know of. So we tried to have a guardian appointed for her. Another month passed.

It turned out the patient has a very close friend who knows about her dementia, so we tried to set things up to have her become the legal guardian. 3 weeks go by.

Except her friend is fairly poor, and it turns out you have to pay to process the paperwork to become someone's guardian, and the friend can't afford it. So then the hospital tried to pay the fees for the friend to become the guardian, but for some legal reason you can't do that, so then the hospital contacted the state government to somehow get them to approve it, or pay for it, or something like that, but then the state said they needed a physician to certify that the patient had dementia that would not respond to medical treatment, which I did, and then the social workers said it would be another 30 days for things to get approved.

When I checked the hospital census a month later, she was still there.

The surprising thing? Her 8-month stay looks like nothing compared to the patient who had been there for 3 and a half years.