Two Minute Drill VI Special Edition: Hell Freezes Over

Physical Medicine and Rehabilitation

“It’s the end of the world! The end is here!” shouted the unit clerk as she pulled out clumps of her hair and rocked in her chair. This sort of thing is normal for a unit clerk so I wasn’t too alarmed until I saw the nurses tearing their scrubs and smearing ashes on their faces. The respiratory therapist pushed a vat of Koolaid towards the back and everywhere I looked there was wailing and gnashing of teeth. When I asked what was wrong the charge nurse, who had changed into sackcloth scrubs, pointed in horror to the “cubby.”

“He’s in there, Panda. Oh the humanity! It’s past 5PM! Surely the horsemen are abroad!”

Cautiously I made my way to the cubby (a little alcove where admitting physicians sit to do their paperwork) and was surprised to see a pleasant-looking fellow sitting at the computer studying lab values. But there was something odd about him. His white coat was not just white but pristine. It glowed under the fluorescent lights and the starched creases on the sleeves crackled as he moved his arm. His scrubs, too, were of a strange color the likes of which I had never seen and they appeared new or so clean that he must have been an ethereal phantom passing unsoiled among his ghostly patients. A shiny, electronic stethoscope with the price tag still on as if it had never been used glinted like burnished bronze from his pocket.

“Hi,” he said, turning from the screen, “I’m Dr. Jones, one of the PM&R residents. I’m almost done admitting one of my patients if you need the computer.”

And I was afraid.

But as I am a good (if sometimes wayward) son of my church and made of sterner stuff than the medical students outside in the hall cowering in the corners in the fetal position, I confronted this impossible creature.

“Spirit,” I said, “whether you come as a dark portent of the end times or whether you are merely a phantasm is it not true that Physical Medicine and Rehabilitation is a specialty which treats a wide range of problems from sore shoulders to spinal cord injuries as part of a multidisciplinary team and whose particular focus is planning and implementing physical and occupational therapy to alleviate these conditions?”

“This is so,” intoned the so-called Dr. Jones.

“And is it not true,” I continued, “that you are sometimes called Physiatrists and part of your dark art is to predict the long term consequences of muskuloskeletal injuries and to develop treatment strategies to alleviate these?”

“In this also you are correct,” said Dr. Jones quietly but with obvious menace.

“Is this not the specialty that deals with prosthetics? With orthotics?” I asked, “Is this also not true? Confess, spirit!”

“All of those things of which you speak are correct,” said the corporeal representation of the entity known as Dr. Jones, “But know you that my dominion extends also to movement disorders, muscle pain syndromes, and even unto manipulative medicine in whose service I have made a dark covenant with osteopathic physicians among whom my name is Legion.”

“But spirit, how can this be?” I was perplexed. “The hour is late. The sun sets behind the hills and you, a PM&R resident yet labor in our department, a department whose walls have never seen the likes of you in the morning much less after normal working hours. Is it not written that a PM&R resident knows not the lethargy of the early morning hour nor does he keep the watches of the night (or the late afternoon for that matter)? Does not your kind slumber on the weekends and know not the sting of call or long hours? How can these strange signs be ascribed to anything else but the apocalypse?”

“Oh, don’t worry,” laughed Dr. Jones, “This is the first patient I’ve admitted in two years. But I’m done so if you’ll excuse me…”

And then he was gone.

We still talk about that day when hell froze over.

12 thoughts on “Two Minute Drill VI Special Edition: Hell Freezes Over

  1. Late to the party over here, but you’re hilarious. I’ve read only a few of your entries and I don’t even remember how I got here (Fat Doctor maybe?) but I like you already 🙂

  2. And ye, the Koolaid shall be spiketh with albuterol, for otherwise the RT shall not be allowed to touch it. LOL

  3. I’m a pmr doc.

    residency? Never admitted anyone from clinic, went in at night a total of 6 times in 3 years, saw the ED one time my senior year because I wanted to see what it looked like.

    Current workweek 8-5, four days a week, Two half days for catch-up or wild card stuff (depo’s, med-legal, academic.) Two full clinic days and 2 full procedure days. Never admit anyone from clinic. Rarely order labs. Phone rang at 1:30 in the morning about 8 weeks ago; this was the first after hours call I’d recieved in three years. Don’t work weekends unless I feel like it.

    Keep in mind that while at work, I am working at a pretty fast pace. Constantly reading, because 1)field is so broad 2)residency focussed on inpatient, which I don’t do.

    I’d choose it again in a heartbeat.

  4. This is not true. I’m currently a resident at a top hospital and take 24-30 hour call approximately 5-6 times per month. While calls are mainly medical management, the focus is on improving quality of life and everything that falls underneath this umbrella. If it were not for acute rehab centers then patients, once relatively stable, would wind up in nursing homes. Heaven forbid you would be in a situation that would require our care but I can assure you if you or a loved one ended up with a TBI, CVA, or SCI you would beg and plead to be admitted to an acute care comprehensive rehabilitation unit as opposed to a sub acute facitlity.

    Many things are entailed in the mix for improving quality of life including managing spasticity, pain, bowel and bladder issues, musculoskeletal disorders, etc. and of course, improving function. Other specialities are vaugely aware of how to address these issues. For instance, how do you manage autonomic dysreflexia or hypertonicity following spinal cord injury?

    Also, many procedures exist to acheive optimal management including inserting and managing baclofen and narcotic pumps, peripheral joint injections, nerve blocks, neuro-ablation, botox injections, electromyography, epidural and facet injections, etc.

    I’d be happy to give you more information if you’d like. Just let me know.

  5. Dude, I’m pulling your leg, Okay?

    On the other hand, if you’re pulling call as a PM&R resident primarily for medical management, you are either an intern (doing your off-service rotations) or an extremely rare breed. PM&R does not admit patients at any hospital where I have worked and, as they are a consult service themselves, would probably just be part of a team that included a hospitalist for medical management.

    I have a tremendous respect for PM&R and highly value their specialized knowledge but let’s not get carried away.

  6. Not getting carried away at all. Just telling you how it is in my residency and all of the other rehab residencies that I’ve rotated through when I was a third year. This leans more towards the rule rather than the exception.
    I’ve already completed my internship and am currently at the PGY 2 level. We have a 60 bed comprehensive rehabilitation unit and we are the primary team that cares for our patients. We admit approximately 7-12 patients per day from multiple services, but never from the ED or ICU.

  7. I wouldn’t say I’m offended by the blog entry, but just a bit confused. I’m a PGY-3 resident at a fairly well-known PM&R program, and I’m taking night in-house call at our free-standing rehabilitation hospital as I write this. I take in-house call about 5-6 times per month while rotating here. It is not uncommon to be paged at 3 AM to go see a patient who is seizing, hypotensive, hypoxic, etc. While learning rehabilitation medicine, I consistantly rely on my internal medicine knowledge and skills that I gained during internship, and quite frankly, have continued to hone during the past 2 years.

    While rotating here or at any of our inpatient rotations (usually the rehab floor of a hospital), I typically admit 1-3 patients daily. This hospital admits about 10-12 patients daily between our spinal cord, brain injury, and general rehabilitation services. On this rotation, I typically work 10-12 hours daily and carry between 16-22 patients on average.

    I decannulate trachs daily, I tap VP shunts, I do LPs, I manage vents, I closely manage medical issues sans hospitalist. This is a normal part of doing inpatient rehabilitation medicine – a part of PM&R you seem entirely unaware of.

    As far as seeing the ER, at our VA hospital, the spinal cord unit is a primary service. If a SCI patient shows up at 2 AM with community acquired pneumonia, we admit them to our SCI service – not medicine. We do this…from the ER (gasp).

    In sum, what you are describing is perhaps the life of someone on an exclusively outpatient-based PM&R rotation. This is but one part of the story. No doubt, the lifestyle you describe is one I aspire to one day, but it does not accurately encompass the entire field of PM&R.

    You say that PM&R does not admit patients at any hospital you have worked…apparently you have never seen a rehab hospital, or a hospital with a rehab unit. There are at least a dozen such hospitals within 2 miles from where I sit tonight.

    I realize it is all in good fun, but I hope that I can open the eyes of you or others who think that we sit around on our hands all day and don’t take care of patients.

     (Dude, I am just pulling your leg. -PB)

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