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24 Hours On Call

MON 1:01PM At noon conference, Ryder asks questions and listens to advice offered by colleagues on how to handle patients who show up late for appointments. Today's noon conference is general internal medicine's quarterly clinic team meeting with the outpatient nurses and secretaries, who give "tips on being efficient in the outpatient workplace—that kind of stuff," Ryder says. Medical topics—like "acute abdominal pain" or "fluids and electrolytes"—are presented other days. On Wednesdays, Ryder goes to the Department of Medicine's weekly morbidity and mortality conference.

MON 2:04PM Ryder reviews a patient's record with nurse Beryl Samuels during "quiet hours" on the unit. From 2:00 to 4:00 p.m., "lights are dimmed and you're not supposed to talk in loud voices, so patients can heal," says Ryder.

MON 2:08PM D'Souza, Ryder, and Laquer are in the residents' team room looking at a CT scan of a patient's chest. Ryder is concerned because the scan shows a lot of fluid that isn't supposed to be there. "Do you want to go to radiology and have it read?" she asks Laquer. While awaiting his return, Ryder and D'Souza continue to write up patient notes, examine test results, and determine plans for patients whom they saw earlier in the day. At 2:20, Laquer returns with the news that the scan shows no clots, but that large bilateral pleural effusions—significant accumulation of fluid between the rib cage and the lungs, on both sides of the chest—are evident.

MON 2:14PM While waiting for Laquer to come back with the radiology report, Ryder munches on a piece of fruit as she reviews medications lists with pharmacy resident Brooks. The team room is designated work space for residents and medical students—a place where they can hold meetings, make phone calls, discuss patients, look up medical information on the computer, type patient notes and orders, and update electronic patient records—as well as eat snacks and store their belongings. Ryder's group shares this particular room with the green team, which works on the same unit.

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