The hospital can be disorientating, to both the patients and its workers. We commonly witness ICU psychosis, a form of delirium that the elderly frequently spiral into while being in the intensive care unit. Several factors contribute to this state, with sensory deprivation being a common culprit. Sensory overload from the multitude of pumps, monitors, and alarms also lend to the confusion.

Unfortunately psychosis isn’t limited to the elderly. Patients of all ages “misbehave”, especially at night. Combine some pathology with an Axis II diagnosis, and you will have a perfect combination of pain. Last evening, I was called to reason with a young woman with lupus who was admitted for renal failure (likely nephritis). She had just undergone a renal biopsy earlier in the day, and we were also slugging her with steroids. She demanded to be discharged. She also had a record of noncompliance with medical advice. When I saw her, it was obvious that she lacked insight to her disease. She had already signed a hospital waiver stating that she understood that she may die if she left the hospital. I attempted to review the consequences of premature departure from the hospital, which included death. She nodded to me, and walked out. Por qué los pacientes castigarme?

Soon afterward, a patient going through alcoholic withdrawal demanded to leave, citing noise. I convinced him to stay by transferring him to a private room and giving him earplugs. Two hours later, he became combative and required sedation.

We have every reason to be confused in the hospital. After a handful of encounters with crazy patients and staff, I became disoriented as well. With GOMERS screeching on 6A (elderly care unit), fluorescent lighting, and wall clocks that permanently read “9:25″, we have every reason to be confused. Every time I walked by the frozen clocks, I had to glance at my pager to reassure myself that time had not stopped. I made every effort to glance out an unshaded window every few hours, even only to gaze at the starlight to reorient myself.

When I step back into the shoes of a layperson, I am always amazed at the tolerance of physicians. After a decade of training and torture in a caste system, perhaps doctors do deserve a fancy house or a fast car. The irony? When I walk out into the parking lot, it’s the nursing staff who have the Beamers, Infiniti’s, and big SUV’s. The physician’s lot is populated with an occasional splurge, but the majority of them are station wagons with car seats, Hondas, Camry’s, and family cars.

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I hate writing progress notes. Sure, they’re essential to document to a patient’s hospital course, but most of the note is repetitive. Even worse, my hospital uses a hybrid medical record system.  The computerized portion stores all laboratory values and initial consults. The daily progress notes by the primary team and consults are all handwritten.  The nursing pods usually have only one or two computers, one of which is always used by nursing to view people.com and perez hilton.  Thus, every morning I vie for that lone open computer while fumbling through illegible chickenscratch.  Do we regress that quickly from grade school? And clearly I’ve discovered that penmanship doesn’t correlate with hand dexterity- surgeon scribble is no better than internist scribble. I’m no calligrapher, but at least I make an active effort to be legible.

This cycle repeats for each of the 8-12 patients every morning for 4 week blocks at a time. That’s enough to push anyone into insanity, or any cynical housestaff to reinforce his jaded outlook on the medical system.  And if slovenly human behavior doesn’t do it, the computers like to seize and go into endless reboots daily around 6am – 8am.  That’s hospital IT (information technology) for ya.

medicine inpt medicine, rant