First time ever: I felt obliged to go spend some free time in the library, reading Mastery of Surgery, a massive set of two volumes which combines discourses on the pathogenesis, presentation, and diagnosis of every single surgical illness, with lengthy instructions and illustrations on how to perform every procedure which could possible be desired – and many which are now only of historical interest. Senior residents have told me that when dictating a procedure for the first time, one could simply read passages of this book out loud, and be correct.
I have read this book before; but today was the first time that I finished reading a chapter, and was immediately paged to go see a patient with that problem. I felt extraordinarily intelligent while talking to him, and to the attending. I shall have to repeat the experiment.
On the other hand, it seems as though my well-behaved collection of patients has fallen apart. All the nice ones have been discharged, and every one who is left is miserable, and angry at me, and at the nurses, and at the whole hospital.
You have to understand. For all that I’m six months in, I’m still very understanding and compassionate, even gullible, towards patients’ complaints. I usually will give as much pain medicine as you could want, as long as there’s the slightest reasonable evidence that it’s warranted. I’ll listen to your complaints about the attendings not talking to you, or not answering questions, and apologize for them. I’ll accept complaints about dietary services. If you need something straightened in the room, I’ll do it, or find someone who can.
But today, it was just too much. Every single patient was furious, about food (or the lack of it), and pain medication (or the lack of it). And again, I feel that I’ve failed to take proper care of my patients if they have to call night float for pain meds. I should be able to adjust things during the daytime, or at least talk through it. But tonight, I signed out in a bad mood: “This one, give her whatever she asks for, it’s not worth fighting. This one, and this one, are going home tomorrow, regardless of what they say, so don’t under any conditions give them iv medications. This is the only happy one on the floor; please be polite to him.”