Another night on call. It’s been a blue-soul kind of day. I’ve pretty much been cranky since I walked in this morning. We changed attendings today, to one that I’ve worked with in the past. Nice guy, but he’s getting older (at least 5 years past the age of retirement, if not 10) and is becoming forgetful and very, very slow to round. I’ve got one patient that I’m convinced that has been misdiagnosed, and I’d love to have an attending that I could brainstorm with, so that we could provide the right diagnosis, but that’s not going to happen with this attending. Instead we’ll wait for the acute illness to pass and send [the patient] home without no additional answers. It’s just frustrating. Neurology, I’ve discovered is 50% crazy people with all types of somatization and conversion disorders, and of the 50% who have real disease, the majority of those, we still can’t do much more than just throw up our hands and say “dunno what you’ve got, but sucks for you.” Even those we think we give diagnoses to explain things, someone follows in the footsteps and doubt even those.

I almost got to give IV tPA for the first time my last call night for an apparent acute stroke. So close. I was so excited, because I was going to do it. I called the attending, he approved it and told me to do it. Unfortunately (or luckily for the patient’s sake), the patient woke up from the self-induced chemical high just prior to me pushing the medication into the waiting veins. Ah, well, I really wasn’t wanting to deal with all of the complications that would have arisen if I had done so.

I got my schedule for neurology next year (the medicine portion is still pending). Two months of NICU (woohoo!), a couple of consult months and a couple of electives. No general ward months. SWEET! At least I’ll have another year to perfect some of my differential diagnoses before I have to be in charge of interns and junior residents. Next year, I’ll have to solidify my plans for my Real Career and actually decide what I want to do with my life and then start making steps to get there by doing research or whatever.

I think I’m running into problems with my licensure application. I submitted it weeks ago, and in typical Wisconsin fashion, I haven’t heard one word from them. There’s a website where you can check the status of your application…. it hasn’t even been listed there. And of course, attempting to email gets silence and calling gets on a merry go round of automated messages and nobody real to talk to. I know that they received it; they deposited the application fee almost immediately, so at least I don’t have to worry about it getting lost in the mail, but it’s starting to get ridiculous. I’m giving them until Monday, before I start calling every day and harassing them. Since I submitted things in pieces, I want to know what they have and what I might need to go back and recollect (my med school verification for example). I have to have the entire process completed by June. I honestly thought that 4 months would be more than enough time, but I’m starting to get nervous now. I think I’ll be saving my tax refund just in case the unthinkable happens and the paperwork doesn’t get processed by June and I’m suspended for a month. I don’t like thinking that, and I’ll be fighting with claws to prevent it, but I’d rather not find myself with no savings and no employment.

My semiannual review is tomorrow, I swear I just went through that. I haven’t seen any of the reviews I’ve gotten from the interns and medical students from when I was the senior resident back in February/March. I’m a little bit nervous about that.

My med students should be done seeing our ER consult, so I’d better get back to work. Ta for now!