While the clinic day officially ends at 5:30 (or 6 or 7), it is not quite as easy to let go of the day. A mix of feelings follow me home, anxiety, hope, frustration, concern and sometimes good old fashion curiousity. Most recently, I saw a wonderful gentleman who reported that he was feeling vaguely unwell, but similar to a time when he had a blood & heart valve infection in the past. He looked well, so we drew appropriate bloodwork (probably more extensive than normal given his history) and sent him home. But apparently my mind did not.
That night, I was plagued by a recurring dream of a heart, isolated from the body, floating in space. (Disclaimer, I have recently been playing Super Mario Galaxy 2 which features many isolated planets, floating in space). Anyway, in this dream, one of the valves was clearly off/infected, and was the focus of my attention. I awoke several times feeling uneasy, unable to shake the dream.
The next morning, after this poor night of sleep, I received an early morning page that the patient did indeed have positive blood cultures, and after admitting him to the hospital, a formal diagnosis of endocarditis It seems my brain was working overtime, trying to warn me of the obvious. Medical residents, working even as we sleep... work hours violation?