#complete garbage

“Satanic Majesty” my ass

After my last night shift, I got home feeling super exhausted and wondering why. I’ve worked those 24-26-32-???-hour shifts before that didn’t leave me this entirely bereft of the motivation to do anything but faceplant in bed, so what gives?

Then I think back to those shifts.

One patient that I was significantly worried about for the possibility of an intracranial mass required an urgent MRI. Unfortunately, given his history, this MRI has to be under sedation. Double unfortunately, he presented to us on the Friday night of the long weekend, making literally everything way harder.

So... here are the steps for arranging an URGENT sedated MRI in my institution:

As the resident, call your staff and review why you are going to do this sedated MRI on an urgent basis, and what timeline you are looking at

Page anesthesia

Wait for anesthesia to call back

Finally talk to anesthesia to ask them to do an assessment on the kiddo (+/- if they feel it’s necessary) prior to the sedated procedure

OPTIONAL: Anesthesia refuses to talk to you until you’ve gotten the procedure approved by radiology, OR the resident tells you to call the staff who you finally talk to then they tell you to page the resident back and ask them to see the patient

Page radiology

Wait for radiology to call back

Talk to the radiologist on call to get approval for this urgent scan based on the patient assessment (ie/this physician is never going to speak to or lay eyes on your patient so you need to really make them understand why they need this scan)

OPTIONAL: Radiology refuses to approve the scan until anesthesia agrees to do the sedation

OPTIONAL: page anesthesia. wait for anesthesia to call back. Finally talk to anesthesia and say radiology is pending approval on whether anesthesia agrees to do the scan.

OPTIONAL: repeat steps 2-5 and 6-9 until the end of time OR one finally agrees OR your staff ends up needing to step in and call staff anesthesiologists/radiologists directly to tell them exactly what you told them but with the authority of the staff

Call the OR booking desk to put the patient on the “add-on” list, and find out a general estimate of whether your patient will be getting scanned that night or the next day so you can determine NPO status and such

OPTIONAL: the OR booking desk refuses to talk to you because you are not staff

OPTIONAL: call your staff to call OR booking desk to sort that shit out

So... I’ve now queued up ALL THE THINGS from step 1-14 with some back-and-forth on a few things but whatever. (During this whole process, of course, I need to manage 45+ inpatients plus see and review ALL the consults that come in for pediatrics overnight and also try to ensure my junior learners are not dying and apparently somewhere in there I’m supposed to find the time/energy/mental capacity to teach them stuff and also go through a similar process for another patient who needs some other thing done that takes a million and a half years... you get the picture. There are only 3 residents on my team overnight, including me. Also, those inpatients we are responsible for include our hematology-oncology ward which sometimes mostly comprises otherwise ok kiddos here for chemo and sometimes mostly comprises kids who are dying of EVERYTHING and you are just doing your best to keep them comfortable and/or help them make it through the night.) That night also happened to be the night of DKAs--we had 3 kiddos in active DKA meaning labs to check literally every 20 minutes while doing all the other things. I don’t know who put the diabetes in the water but please stop...?

Ah yes, now it is finally morning and I feel a little shell-shocked by how much crap needed to be done all at once, but that’s okay. We did it. We arranged the urgent sedated MRI, among all the other stuff overnight, and all the kiddos did okay! The DKAs are corrected, the heme-onc kids are mostly on ALL the antibiotics (and ALL the pain control), and my junior learners had a chance to eat overnight (I think?).

We finish morning handover, and the poor weekend day team looks like they’ve been hit by a truck. Fortunately, there are approximately 7 of them to take care of all the messes the 3 of us made overnight.

...except then one of the nurses pages us urgently to tell us that my patient’s MRI is NOT happening that day?!?!

So of course this leads to repeating steps 6-8, which turns into this weird discussion about how the radiologist who was on call yesterday approved the scan and INSTRUCTED US TO GET THE KID ON THE OR ADD-ON LIST FOR A SEDATED MRI but no one apparently told the radiologist on call TODAY, and therefore oopsie they’ll do their best to scan the kid today but it MIGHT NOT HAPPEN?!

NO. I made it explicitly clear that this MRI could not wait until tomorrow, it had already waited until today and WHAT PART OF “THIS KID MIGHT HAVE CHRONICALLY INCREASED ICP AND THEREFORE COULD SUDDENLY DECOMPENSATE” DO YOU NOT UNDERSTAND? Perhaps it’s the part where the people managing that decompensation is NOT the people who have the power in arranging these scheduling things?!

So I stayed a few hours after my shift had ended desperately trying to sort this crap out so my colleagues covering the daytime won’t have such a ridiculous issue on their plate. Unfortunately, this does not work. I discuss with the daytime SPR and the staff, who agree that if we can’t do the MRI then they’ll use the sedation slot to just do a sedated CT, which will hopefully mean that if there’s something that needs to be urgently addressed by Neurosurgery, they can either take straight to the OR or neurosurgery can--you guessed it--push for the sedated MRI.

-----

One of my friends asked me, “If you had the opportunity to do what you’re doing all over again, would you do it?” and I told him, “I probably wouldn’t want to do medical school again, having already done it. But pediatrics is what I want, it’s what I think I’m meant to do. The ends here might justify the means to me.”

Then I think about this BS that we put up with in residency and in our system, and I just... things need to change. Bear in mind that this was my take on the situation, and fortunately the kiddo was blessedly stable throughout all of my scrambling and running around and crying on the inside. The bottom line though? He needed a scan and he was being denied this scan because of stupid semantic BS and systems holes and issues that are not his fault. They’re not my fault, either, and I have to keep reminding myself of that when I am then the one that goes to the incredibly anxious and stressed family to tell them, “I’m sorry, but the scan is going to be delayed.”

There is no way that is fair. This family is already fearing the worst--they thought they were getting their kid checked out for a constellation of weird symptoms that other doctors had seen before, but then they got alarmed because the doctor at their endocrinology appointment brought in an opthalmologist to do an urgent fundoscopic assessment for papilledema, and then they were being told that they had to get an MRI ASAP. How could they possibly hear something like that, then be told, “I’m sorry, but the scan is going to be delayed”?

/sleep-deprived over-stressed rant

[Shift 2/7. Wish me luck.]

They both have excellent, very personal reasons why they feel the way they do. This is a very important conversation for them to have as a serious couple, as it could be a significant measure of how compatible they are as a couple.

Lena owns a gun. Lena has a very good reason to own a gun. Her life is in danger almost constantly, and having been arrested at least once before probably doesn't give her much faith in the police to protect her, and now that she's on the outs with Supergirl she probably doesn't trust that SG will be so quick to come to her rescue next time. (I would also like to know when she used her gun to protect herself. It sounds like a story and we haven't seen it, so...)

Meanwhile, James has the complete opposite viewpoint. Carrying a gun would only endanger his life as a black man in today's America, and how many of his fellow black Americans have been murdered by guns? To him, guns are the problem, not the solution. He also has the long view-- of children having the right to go to school without fear of dying, etc.

I would also argue that Lena is the more pivotal argument, rather than the gun manufacurer. He's easy to understand-- he wants to make money, and we don't expect him to change. But Lena? Lena, who cares about the greater good, who has only ever wanted to help people, and still owns a gun and believes in her right to own one?

She's the kind of person we're more likely to come up against in our own lives, and therefore far more impacting than a single scene with a 'stache-twirling cartoon of a Mr. Moneybags trope.

So, maybe James lets the subject slide the first time it comes up at CatCo. I get it-- he likes Lena, they're in a good place, he doesn't wanna chuck it out the window. Not to mention, it comes completely out of left field that Lena Luthor to share an opinion with the  cling-to-your-guns conservatives, so he's probably reeling a little bit.

But even after he regains his bearings, he can't get it out of his mind. So he comes back to Lena armed with an argument the show itself has primed itself for:

"The government expects aliens to register themselves as possible threats, but you don't think we should register weapons that are specifically designed to kill people?"

Lena blinks in surprise, then creases into a mix of confusion and indignation. "I support gun registration, James. I acquired my handgun through legal means, and ensured it was registered with NCPD when I moved to National City. I take regular refresher courses on its use and care, and keep it secured when not on my person-- and yes, I have a registered concealed carry permit as well."

James doesn't know how to respond to that.

"I agree that we need better gun control measures, but I don't agree that outlawing guns for all private citizens is the solution. And I'm not speaking from a place of nostalgia for frontier americana, but from one of practicality. There will always be those who have access to guns, through legal means or otherwise, and people have a right to protect themselves in kind."

Maybe they go deeper than that, and explore that Lena only supports government oversight to an extent-- that ultimately, she doesn't trust the government to decide who deserves a gun and who doesn't. Or that she ascribes to a slippery slope mentality regarding gun control.

But they find some kind of middle ground where James is assuaged that Lena isn't advocating arming teachers in schools or using the terror watchlist in lieu of actual background checks, and Lena feels she's been heard and understood and that her boyfriend doesn't expect her to live defenseless when the entire world seems to want her dead.

And we think that's going to be it-- we get the bad guy and our inspirational speech or whatever, but then... our button scene is the CatCo office, late at night. James is still troubled when Lena walks in and finds him slouched in his chair. Their eyes meet, and we can feel the disruption in the bond between them as Lena wordlessly slides a slip of paper across the desk.

"What's this?" James asks.

"A receipt." Lena holds his gaze. "I surrendered my handguns to NCPD this morning."

Whatever James expected her to say, it's not that.

"Really?"

"I've been thinking about what you said. And while I still think you're idealistic, you have a point."

"You do too," he tells her, coming out from around the desk. "And I'm sorry I tried to minimize that. The threats you face are real, and you deserve the right to defend yourself."

To James' surprise, Lena lifts one shoulder in a shrug. "The kinds of enemies I have lately, a gun won't help me. Me giving up my personal weapons isn't going to fix anything, but... it has to start somewhere, right? So why not with me."

James wraps her in a tight hug, and he can feel some of the tension bleed out of her as her arms circle his waist. She leans into him with a sigh. "You're amazing, you know that?"

"I'm selfish." Her voice sounds thin against his chest.

"What?" James pulls back in confusion. "This is the exact opposite of selfish."

"You want to know what actually prompted me to do something about it?" Lena asks. "It wasn't what you said about children going to school, or police brutality... I make donations to gun control lobbies, but the hundreds of people who've already died from gun violence this year weren't enough for me to make any changes to my own life."

James regards her softly. "Then what was it?"

"The cult you saved Tanya from-- they had guns. Probably through the same proper channels I did. And they used them to shoot you in the head."

Green eyes sparkle with tears, filled with self-reproach and anger. "That's what made it real for me. So apparently I only care when it affects me personally. I'm that person."

"Hey," James interjects, taking her hands in his. "You're one of the kindest people I know, and you've done as much good for this city as Supergirl. Honestly I don't know how you care as much as you do-- about everything."

Lena doesn't look convinced. James cups her cheek, willing her to hear him.

"You are an inspiration to me, Lena Kieran Luthor. And I'm lucky to know you."