I'm tired...

I am officially on my last month of internal medicine in residency. Some of you already know what that means...for the bulk of you, however, I'll explain it. Internal medicine rotations are difficult. You're on call every third night, you try to learn lots of obscure information, and you fufill the title that you are given...."resident." More plainly stated, you live, eat, and breathe hospital. You get your days and nights mixed up because the call room doesn't have a window. You know Marge's dog's name (she's the cashier at the hospital cafeteria.) All the days seem to run together into a big exhausted clump of sick old folks and alcoholic young ones with an occassional witty remark from an internist thrown in for good measure. ahhh..

Last night, I was on medicine call and I did something I have never done before, and I really hope to never do again. I didn't realize how tired I really was. I was up admitting some guy with abdominal pain at 1AM. When I was fininshed with the admission, I picked up the phone to dictate a note. A dictated history and physical usually takes about ten minutes and is two pages in length. After you're done dictating your patient, you get to go home. I must have been awfully comfortable in my chair on 4 West. I remember dictating this guy's current history, family history, social history, exam, labs, x-rays...*yawn...* I have to hand it to myself...the guy was a boring patient, especially in the middle of the night. He had constipation! Who comes into the hospital at midnight because they are consitpated? I know the answer to that. A bored someone, that's who.

ANYWAYS, I was dictating along in my soft warm chair with my decaffinated beverage at my side, going through this gentleman's normal labs and normal x-rays...and then I honestly don't remember anything until a nurse came and poked, me in the shoulder.

"Doctor Sprengeler?"

(jerking awake) "Huh?"

"Um, I hate to intrude, but are you sure you know what's going on? You just dictated that your patient was scared to go to school because Mister Caleb makes her go pee pee in the big potties."

...

Yes, you guessed it. I actually fell asleep while I was dictating. And I was dreaming. AND, I was dictating my dream right to the hospital transcriptionist! Bring on the ambulance chasers, this doc has gone officially insane.

Good thing I still had the receiver of the phone in my hand and I could go back and delete what I had dictated. The assessment and Plan section of poor Mr. Constipated's history and physical started out making sense....place an NG tube, pain relief, zofran....but suddenly, things changed. My dictation/dream morphed him into a little girl who wanted to sit on the potty chair instead of the big potties in the preschool room. Oh dear.

It's after eleven. I should be in bed.