An open letter to all the doctors I know:

You guys are going to cost me my job, my sanity, and my freedom, not necessarily in that order. What's going to happen is a mass slaughter of people I normally like and respect and depend upon, and then I'll get arrested and from then on things will suck.

But! There's a chance to turn this boat around, to make sure that you all keep your collective and individual lives and that I keep my happy-go-lucky personality. Everything rests on these four littleish words:

Neuro Critical Care Unit.

That's where I work (and what I kind of by default, without really wanting to, find myself running sometimes).

In order for you, beloved Medicos, to admit a patient to the NCCU, they have to meet two criteria: they have to have a Neurological Problem and need Critical Care.

That means that the dude who's been stable neurologically for two weeks but who needs frequent suctioning does not qualify. Frequent suctioning is not a Critical Care Function. Likewise, if you feel like your completely intact, rock-stable patient doesn't get enough attention (I wish I were making this up) on the acute-care floor, you can't just transfer them to the NCCU so that they'll get their little paddy-paw held.

I know that seems unfair. After all, we have three whole beds in our NCCU, and you want your patient to be taken care of! The thing is, though, that those beds are generally reserved for people who need




For instance, if somebody has a stroke as a complication of surgery, that person would be transferred to the NCCU. If somebody else had a dimunition of mental status after anesthesia, off they'd go to the NCCU for observation. If a third person had an aneurysm coiled or glued or otherwise dealt with in a minimally-invasive manner, they'd come to us. Most of all, if some poor sot came into the emergency department at Holy Kamole with an occlusive stroke, they'd be transferred, hospital to hospital, for what's known as "definitive management".

"Definitive management" means that we do Neurological Critical Care.

And Neurological Critical Care does not mean--and I want to stress this again--scheduled, every-three-hour nasal-tracheal suctioning for somebody who's otherwise a candidate for a floor bed. It does not mean transferring a walkie-talkie patient to the unit because you felt the nurses on another floor "weren't seeing him enough". Level of care is not an indication for our unit. Level of acuity is.

Unfortunately, and I'm looking at you, Medicos, anybody who needs Neuro Critical Care this weekend and into the start of next week will be, in the words of Queen Victoria, shit out of luck. Because you've filled my three! whole! beds! with your personal pets, thus leaving no




beds for people who might actually need them. Yeah, I suppose we could send people to the surgical critical care unit, but they're not specialists on strokes. We are.

And we can't exactly do a whole lot of transfers in and out, to the floor or the SCCU, because there are no open beds in the hospital.

I explained this all to you, and even got a little short-tempered (and I normally love you guys and gals, really). The house manager explained it to you. The charge nurses of at least two units explained it to you. And still, when I left yesterday, I had a unit full of people who did not need




Poor Jo (Der Alter Jo) had her dinner interrupted last night when I called her from the car to vent. Doctors mine, the first words out of my mouth at the end of the day should not ever have to include reflections on your personality or your parentage, followed by the phrase "Good holy God I need a new job."

Please do not do this any more. Admit the people to the Neuro Critical Care Unit who are both Neuro and Critical. Do not admit the people who are not. I don't know how to make that any simpler for you. Please do not make me try; "simpler" at this point might include "pounding it into your head with a half-roasted ham."

Hugs and Kisses,