I’m still not doing well with this independent judgment thing. I really hate having to put myself on the line: take responsibility for having gathered all the relevant facts, for having weighed them correctly, and for having chosen the right course of action – without checking with anyone else first. It’s kind of like the difference between practice test questions, when you can look at the answers right away and see how you did, and the real test, where you just have to plunge ahead, and wait a few months to find out whether you were right or wrong. That’s the nature of being a doctor, but after spending eight months accustoming myself to checking everything with a senior, no matter how confident I am, and being chewed out if I fail to do so, this is a little bit of an adjustment.

Very very uncomfortable. I spend long periods of time sitting in front of the computer with my head in my hands, trying to make sense of the patient. It doesn’t help when the way the patient looks – fairly comfortable, not too particularly sick – doesn’t correlate well with the awful numbers in the computer (white count, creatinine, fever, tachycardia, borderline hypotension, any combination of those). The nurses keep asking if I’m ok, and then they want to know if I’ve decided what to do. Ha! I tell them, “Let’s start with these two things, and I’m sure in five minutes I’ll think of some more.” So far they’re not complaining too much about me changing the plan ten minutes later. I try to limit it to one change of plan per patient episode. The second plan better be the right one.

Towards the end of the night, the pressure gets to be too much, and I call one of the other surgery residents, just trying to share my indecision. He, of course, doesn’t appreciate me trying to get him to do my work, especially seeing as how he’s got way too much work of his own to do. So far he’s been fairly decent, but I’m furious with myself. So weak. Resolved, not to call him at all for the next two nights, at least. Rest of the month would be better.

Really, it’s not worth all this worrying, because every time I break down and call somebody to check, my plan has been pretty good. A few details one way or the other, but nothing major. The differences could all be put down to individual preference. I’ve got the basic concepts – fluids, electrolytes, add this drug, cancel that one, call a consult, the consult can wait till morning. If only I could trust myself, without giving up and asking someone else.

And then the attending (encouragingly) remarks, “This is a surgery patient. You don’t need anyone else. A surgery resident should be able to manage this patient. Of course, he’s so complex that once you know how to do this, everything else is simple.” Thank you so much, doctor. That makes me feel so much happier about being alone in the hospital with him.

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