I’m starting to be familiar with the way the last day of the month feels. Once again, I feel as though I’m abandoning my patients. I didn’t think they were that complicated, but now that I come down to it, making final notes in their chart, and trying to arrange a succinct sheet of notes to hand over to the next intern, there are so many small details, important to the patients, but so small that I hardly ever mentioned them to anyone else. I know I forgot to say some things, or else there were others so small that the other residents would have laughed at me for trying to sign them out. I hope – I know that they’re just as conscientious as I am, and that they’ll quickly pick up the details from the chart and the computer, and from talking to the patient. Within a day or two, they’ll own the service as much as I do now.┬áBut it’s hard to let go.

And then all the details of the new service. Starting night float again is in some ways better than starting a proper service – I’m not directly responsible for making a care plan happen, or for arranging discharges, so it’s not as important for me to know the details. On the other hand, I’ll never be told properly about most of these patients, especially since the groups I’ll be covering for next month are notorious for never signing out, or for signing out very badly when they do. So every night will be full of surprises; and at night, every surprise is unpleasant.

This rotation has showed me how much I actually enjoy simply taking care of patients – checking on them, chatting with them, making sure that everything is being done appropriately for them – separately from doing surgery. In fact, having to go to the OR can be frustrating when it keeps me from giving priority to the floor patients.

This would have made me concerned that I may be in the wrong field – after all, liking to talk to patients and arrange diagnostic tests is not a hallmark characteristic of surgeons – except for two things. Today I spent fifteen minutes talking to a friendly psychiatrist about one of my patients. He was very nice, and I was ready to scream. The amount of serious thought which he was giving to her behavior was unbelievable. He was puzzled by her. I think, perhaps rashly, that I have a decent understanding of her behavior. I couldn’t perhaps tell you whether she has factitious disorder or Munchausen’s disorder or psychosomatic disorder, but I can tell that her only problem is supratentorial. I don’t want to think about it beyond that.

Secondly, I spent some time at a medicine conference last week. You may well wonder why I was there. The subject of the conference was how to improve a particular area of patient care, and we had been warned that the general conclusion would be, that the surgery residents were failing to carry out certain responsibilites. So a contingent of us attended in order to hear what would be said about us, and to defend ourselves/share our opinions, if called for. I had forgotten what it was like to think and talk medicine-style. Of course, I didn’t start off with a very open mind, since the purpose of the conference seemed (to us) to be to blame some very competent and professional surgery residents; but I also remembered how glad I was that when I look at a patient, I’m looking for an intervention that can happen right now, not for how to adjust some medications gradually and watch for results over several days. I don’t have the patience or concentration for that kind of thinking.

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