Things That Go 'Beep' in the Night

My first night of surgery call. I survived it. More importantly, so did every patient under my care. Even the guy on the colorectal team (i.e. under the other surgery team's care and therefore a total stranger to me until something goes wrong and he needs me to know everything about him) who was supposed to die (according to the resident on his team) was considerate enough to keep on trucking until the light of day broke over the many montiors and buzzers that echo through the halls of 4Z in the middle of the night.

It actually wasn't too bad. The time went quickly until I finally dragged myself to my call room at around 2am. Things were steady, but not overwhelming. For my first few calls I have a senior who serves as my back-up. I saw a few consults in emerg, my clerk saw one from another service (and reported it back to me... I could get used to this 'delegating responsibility' thing) and there was the usual scut from the floor. I don't mind scut. It makes me feel competent.

"What's that nurse? Your patient can't sleep? Well, let me, the incredibly useful and competent intern, give you a verbal order for Ativan 0.5 mg PO qhs prn, thus SAVING THE DAY."

Or not.

But don't think that hitting my military-issue hospital cot at 2am was the end of my night. Oh no. After about 45 minutes of hard-earned sleep, my pager went off. It was the emergency room. Uh-oh. Another consult. But no, it was a nurse asking about a patient who had come to emerg after being discharged by general surgery the week before. This was a 34 year old guy who had apparently, for reasons that are still unclear, taken a 30 foot swan dive from a building resulting in some nasty internal injuries. Apparently, she had been collecting a stool sample from this guy only to find that instead of stool, his bowels had produced a thick, mucous-like substance that was yellowish green in colour. She wanted to let me know.

"Um, thanks."

"Well," asked the nurse impatiently, "what is it?"

I decided to be honest. "I have no idea."

"Is it normal?"

"Beats me."

"What should I do about it?"

I paused. It was just before 3am, and I was in no mood to play 'guess the bodily fluid' with this nurse.

"Look, is he being referred to us? Is he direct to general surgery? Are we responsible for him in any way?"

The nurse admitted sheepishly that we were not.

"Then I really can't help you."

I am not in the mood for pleasentries at 3am.

About 20 minutes later I ended up down in emerg for another consult anyway. While I was down there looking at the notes on the patient, I overheard a nurse on the phone with the orthopedic surgery resident.

"But it doesn't even LOOK like stool, it just looks like mucous. What should I do about it?" She apparently had not given up on her quest to find someone to identify whatever the hell was coming out of this guy's ass. A moment later, she hung up the phone. Another nurse asked her what he had said.

"He said to put it in a sample jar, send it to the lab and leave him the hell alone."

Word.