I am, again, pleased with myself. We have a patient who’s septic from quite mysterious reasons (well, I suppose positive blood cultures ought to explain why he’s septic, except you still have to figure out how it got in his blood, and why he’s growing, as the nurse said, “everything but the kitchen sink” in there – gram positive cocci, gram negative rods; gram positive rods, gram negative diplocci; and who knows which of those to believe). (Not to mention what he’s doing on the trauma service; but that’s another perennial issue, how we end up with general surgery, orthopedic surgery, neurosurgery, and downright medical ICU patients on our service. Educational, but frustrating.)

Anyway, the a-line was going bad, and we needed another one. I spent nearly two hours on him, and had to ask for help, but in the end got my own line in the brachial artery. Which is technically a no-no, since the brachial artery (at the elbow) is the only major arterial supply to the hand (unlike the radial artery, at the wrist, which is duplicated by the ulnar artery), and if it gets in trouble, you have a serious problem. But it was acceptable in this patient, who had no other arterial access; and my first brachial line.

Plus, later in the day, running more trauma resuscitations, with the attending standing by making sarcastic remarks about me and all the other staff: “You’re forgetting something, Alice. . . You don’t know what you’re forgetting? . . . Does the patient have iv access? You can’t trust these nurses when they say they have an iv. You have to check what gauge it is. Just because it’s there doesn’t mean it’s working. These nurses don’t care about ivs, just about drawing blood. . . Are you going to get an xray? Where are the xray techs? Do they not come to traumas anymore? You are going to get an EKG, right? You wouldn’t forget that, hmm? Make sure you look at it yourself, because I don’t trust these ER doctors.” And so on. All true, that I ought to be doing those things, but really not helpful to be ripping up the staff while we’re trying to work together on something. Now I know why the seniors have all developed this particularly flat, matter-of-fact voice for using in the trauma bay. It’s the only way you can answer him.

Now if I could figure out how to stop getting chewed out by the trauma attendings for things I didn’t do – in fact, wasn’t even in the hospital at the time – life would be better. So far I and the other residents just duck and don’t say anything; and that’s the only thing to do. But I’m going to get tired of being rebuked for things I couldn’t even theoretically be responsible for.

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