It's a Zoo

Back in the Emergency Room for my glorious last waning days of my residency training...it's a little weird to be ending my time down there, as opposed to doing a regular rotation working with the standard Internal Medicine faculty. Instead, I'm trapped in the ER, which is constantly in state of near-chaos at best and zoo-like catastrophic frenzy at worst.

Over the years I have fortunately gotten to know many of the ER residents and attendings, and overall this makes it a more pleasant experience. As a young Medicine resident, it's easy to get royally pissed off at the ER for being the source of your painful admissions and not always obtaining an accurate history and physical. After rotating through the Emergency Room and realizing the sheer volume of workload the ER has to deal with, most residents (including myself) are far more understanding and respectful of the job that ER doctors perform. In fact, if it weren't for the fact that most research careers don't really jive with a career in Emergency Room, I would even consider doing ER Medicine myself. These docs truly are on the "front lines" and the ER is often where a lot of the fun stuff of taking care of truly sick patients takes place.

I did another lumbar puncture (a.k.a. "spinal tap") yesterday. I've gotten quite good at them, if I do say so myself, largely as a result of my time in Africa, and in a weird way I will miss doing them (you don't really need to do them ever as a Nephrologist). Yesterday I was one red blood cell away from getting a "champagne tap", one of the great traditions of Medicine. The tradition is as follows: when you do an LP, you get back spinal fluid, which should in normal situations be completely clear. You look at it under the microscope, and then count how many red blood cells (RBCs) and how many white blood cells (WBCs) are present in each high-powered field. A "champagne tap" is when your spinal fluid shows 0 RBCs and 0 WBCs in the fluid in two separate tubes, which is usually indicative of a superb job of maneuvering the spinal needle into place without any undue trauma. Most importantly, if you obtain a champagne tap, your Attending has to buy you a bottle of champagne as a gift! Yesterday my tap showed 1 RBC and 0 WBC in tube 1, and 0 RBC and 0 WBC in tube 2. So close! And thus is the elusiveness of the champagne tap...