The Hospitalist

Once upon a night shift dreary while I sutured weak and weary

With bloodshot eyes and vision bleary, drunks who fell upon their floor.

While I nodded, nearly napping suddenly there came a tapping

As of someone gently rapping – Rapping at the triage door.

‘Tis some visitor I muttered tapping at my triage door.

Only this and nothing more.

 

Ah, distinctly I remember it was in the bleak December

When every medical staff member refused to admit patients to the floor.

Eagerly I wished the morrow.  Vainly I had sought to borrow

From Up to Date surcease of sorrow – Sorrow for the lost Med-Surg floor.

For the dumping ground of soft admits whom we lovingly called  “the floor”

Roadblocked here for evermore.

 

As night dragged on, I kept on hearing faint sounds of a smug throat clearing.

I felt as if someone was leering just outside my triage door.

Open here I flung the curtain.  And before me stood I’m certain

The most stubborn hospitalist the world had ever seen before.

“By the time this night is through I shall thoroughly torture you

For each admission I shall eschew.  You shan’t gain access to my floor.”

This he said, and nothing more.

Raven2

From the depths of a nursing home sat a frail and febrile gome

Quite demented and alone with soggy diaper and bed sore.

It was just as I suspected – her urine sample was infected

And her sacral decub once inspected, smelled like low tide at the Jersey shore.

Surely this one is a keeper.  So I paged that stonewall sleeper.

Awakened him by way of beeper, summoning him to the ED core.

To my dismay he was not impressed.  He had her bed sore promptly dressed

As he condescendingly stressed her urine was colonized since days of yore.

“I know you are a non-believer.  But how do you explain her fever?

Shouldn’t she be a receiver of Rocephin on the Med-surg floor?”

Quoth the hospitalist –  “Nevermore”.

Raven1

An obese smoker with hypertension felt chest pain and apprehension

With marked ST segment depression in leads V1 through V4.

“I got him now” I proudly shouted.  A diagnosis rarely doubted!

His EKG I smugly touted as I paged the hospitalist once more.

But my pride quickly turned to shame.  The hospitalist had upped his game.

He found old EKGs that looked the same going back to 2004.

The hospitalist smiled as he held court – letting out a mighty snort

And he read a cath report dated from the month before.

“Clean vessels” he said with an evil smile.  Partly sweet, but mostly vile

“Further workup is not worthwhile”.  “23 hour obs?” I did implore

Quoth the hospitalist – “Nevermore.”

Raven3

A diabetic with a sweet diagnosis – hyperglycemic with gapped acidosis.

Surely this man’s poor prognosis could gain him entrance to the floor.

Full of pride and seething rage I demanded an overhead page.

Time to rouse the slimy sage who had denied me twice before.

I should have known that I was hosed, for when admission was proposed

His anion gap had promptly closed and his pH was 7.4.

“You fixed him here” the hospitalist said as he patted me on the head.

“Did you get me out of bed just to settle some old score?”

I begged and pleaded with all my might – “Just keep this guy for one night.

Transition him to sub-Q right so he won’t bounce back sicker than before.”

Quoth the hospitalist –  “Nevermore”.

Raven5

A chemo patient was in room three.  I knew she was in D.I.C.

As anyone could plainly see blood oozing out her every pore.

I’d like to see this one get blocked.  If he can punt this I’ll be shocked

The inpatient gates shall be unlocked.  Of this I’m certain and quite sure.

Cockiness was replaced with despair.  The hospitalist made her comfort care.

He hung a morphine drip with flair and cranked it till she breathed no more.

“You couldn’t let her say goodbye or give her family time to cry.

When oh when will you finally pry open the locks to the med-surg floor?!”

Quoth the hospitalist – “Nevermore”.

Raven4

“Be that word our sign of parting, you useless tool” I shrieked, upstarting –

Get thee back to the call room where you shall torture me no more!

Leave no consults as a token of the venom you have spoken.

Leave my loneliness unbroken!  Slither back up to the floor!

Take thy calipers from out my heart and take thy ass from out my core!

Quoth the hospitalist –  “Nevermore”.

 

And the hospitalist, not admitting – still is sitting.  Still is sitting.

While night nurses are bullshitting as their relief walks through the door.

And his eyes have all the seeming of a demon that is dreaming

Of new excuses and clever scheming to keep my patients off his floor.

And my soul crushed in defeat, trampled beneath internist feet

Shall be lifted – Nevermore.

 

What do you think?  Have you ever been tormented by a stubborn consultant?  Did this blood curdling tale strike a chord?  Share your thoughts and comments below.

 

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22 thoughts on “The Hospitalist

  1. I was all set to release a poetry post this week, small world. I am going to link yours in my post when it comes out because I think this is very creative. Next you could do ‘The Tell Tale Heart (Arrhythmia)’

    Like

  2. Love love love it.

    To have such power! I’m a peds hospitalist and the game is much different. We are at the whims of the ED. All kids that the ED thinks should be admitted are admitted!

    Even better, I get to argue with the insurance company after the fact when those soft calls I had nothing to do with get denied!

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    1. The true stonewalls are few and far between. Luckily, after 8 years working in the same place I know the hospitalists really well. They all owe me favors from times I’ve been called up to the floor to respond to codes or intubate patients.

      One of my side gigs is reviewing charts to determine if they meet inpatient criteria. Oh the irony of paying an ER doc to critique the appropriateness of hospitalist admissions!

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  3. Impressive work here, SHS.

    For what it’s worth, I have not once refused an admission in my anesthesia career. Of course, I’ve never accepted one, either.

    Have a cheery holiday!
    -PoF

    Like

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