On-call again

Yes, I am on-call again... ugh. Tonight I have (almost) real responsibilities, though, so it's a much better experience. The infectious disease pager was forwarded to me, so now every time a nurse has a question about vital signs or medications, I get the page. Most of the questions thus far have been fairly simple--so far I have gone and talked to a patient about why he needs to take his medications, told a nurse reporting that a temperature had a fever that he can have Tylenol (I talked that over with the intern first; I can't just arbitrarily prescribe medicine, even Tylenol, and had to defend why I didn't think the fever was a sign of serious infection), and turfed a question about pain medicine on to the resident. At some point, we'll probably have a slew of admissions (we discharged quite a few people today), so that'll keep me busy, but for the meantime, I'm debating whether or not I should go find a call room and crash until the pager goes off again.

Other than the multitude of discharges, it was a fairly typical day. I arrived at 6:15ish, saw my patients, and we did the whole rounding thing. My patient with the reaction to Bactrim was officially transferred to the burns service today, because they finally realized that his HIV wasn't really an issue, at least compared to fact that his skin was falling off. He was by far the sickest on our service. The man who is growing fungus out of his lungs is now also growing mycobacteria (the same group of bacteria as tuberculosis and leprosy, but it isn't TB or leprosy), so I decided that he's just cooking up a microbiology lab in his lungs. Thoracic surgery was going to take him to the OR today to cut out the fungal badness, but they had too many emergent surgeries today, so now our patient is on their schedule for early next week. He is not happy about having to wait around in the hospital that long (and because he's on IV antifungal meds, he can't just go home and then come back next week). Other than that, everyone was fairly stable--improving, but not quite ready to go home. I also got to show off my future-preventive-medicine-ness: our patient with TB finally had three negative screens for TB, which means that we were able to take him out of isolation. He said he had done this before, but the Ohio Department of Health didn't have records of it. So I called ODH, informed them of the situation, got their fax number, and then called the microbiology lab at the hospital and asked them to fax the microbiology reports to ODH so that they were aware of the situation. It was a proud moment for future preventive medicine physicians everywhere, I'm sure.