At least on tests, when you manage a patient wrong, he goes away and stays away. In real life, my patient started having problems at midnight, and, despite me repeatedly choosing the wrong answer to every question, he wouldn’t stop. (I wonder why.) Sometimes, if you wait long enough, the problem will just go away. Sometimes, the purpose of a patient’s tachycardia seems to be to induce tachycardia in the caregiver; once it’s done that, it just goes away.
Not my patient. I was trying not to be concerned, but after three stat pages from one of the worst floors in the hospital (within the space of two minutes, so it’s not like I was ignoring them), I decided I would have to postpone my other (equally) sick patients for the time being, and trust their more seasoned nurses to handle things calmly, while I went to investigate. At first I think I had it fairly under control, but as the patient seemed sicker and sicker, and the nurses seemed to be all running in circles, and plainly stating that they didn’t know what to do, and asking for help, I gave up and called the pre-code alert. I tell myself it was because I wanted to get the monitor, and the labs drawn, and the xray, and yes, maybe the medicine attending, to come, rather than having to wait slowly and page everyone one by one. Partly it was a conscious, calculated decision on my part. But partly I panicked. And there were some other bad judgments I made, too, and various persons who explained them to me, very politely, and laughing just to themselves. (In case you’re wondering, in this hospital, surgery doesn’t call pre-codes. Either it’s a code, and you call it, or it’s a sick patient, and you manage it quietly. Don’t panic and just randomly page every support service in the hospital.)
Anyhow, every time I thought I had the guy stabilized, he’d break away and do something different. He wouldn’t even be sick the same way twice. Every time I thought I had figured out what was wrong, he went and did something else. . . I was still getting paged about him, an hour after I left the hospital. . . At least so far he seems to have survived spending the night with me. . .
Even more than a few mistakes tonight, I’m starting to be seriously worried about next year. When I get in trouble now, the knowledge that I can call my senior, and he’ll show up, calm, slow, deliberate, asking all the questions I’ve forgotten, and then come up with a rational plan, is a tremendous strength to lean on. I know it’s not easy. I can see how heavy it is for him, handling upwards of a hundred in-house patients and two semi-lost interns (up from completely lost, at the beginning of the year), plus craziness from the ER. But to me, he’s always the guy with an answer. In three months, there are going to be interns looking to me for an answer; and I can’t even come up with one for myself, now, with a small group of patients to handle.
And I’m watching the chiefs more. If the senior residents think they have a hard time – horrific months of nights, where your pager never stops and every page is about a serious problem – I can’t imagine how the chiefs handle it. They get called a couple times a night, every single night, all week, all but a few weekend nights a month, for two years straight. A couple times every week, they have to come in at night to operate, and they don’t get any breaks during the day, or the next night, just because they’ve had a long night. Some of them give up and are irresponsible, and everyone dislikes them: how can you be the chief, and dare to say you don’t know about a patient on your service? The others, the ones who know every single patient’s name, and labs for the last three days, and pathology, and cardiac history, and answer back the minute you page them – we honor them, and are very glad not to be in their shoes yet.
Then of course there are the attendings, who are a level yet beyond the chiefs, and who also get called always and forever and at all times, and who have to have the final answer for everything – no one to save them if they’re wrong – tell me again why I’m getting into this?