I continued my attempts to be in three places at the same time, to no one’s particular satisfaction. I ought to pick one place to be, and do a good job there, and then at least those people will be happy, instead of all three groups being displeased at once. I can’t somehow manage to 1) round with the attending in the trauma unit 2) discharge patients in another unit 3) be present for resuscitations in the ER, all at once. Result, patients are not discharged in a timely fashion, the unit attending is displeased because I’m not continually present, and don’t everything about all the unit patients, and the admitting attending is displeased because I’m rushing in and out of the resuscitations, and trying to get done with them as fast as possible so I can go back to the unit.
(In addition, there are a few secretarial jobs that the residents absolutely have to do, and somehow they’re always lowest on my list of priorities, which means the attendings who care about secretarial details will be out for my hide after a few more days of this neglect. I know it’s coming, and I still can’t find the time to get it done, even with spending 14-15hrs in the hospital.)
And I’m upset with myself, because I miss details on my own unit patients, and because the interns I’m supposed to be supervising turn up all day long with surprising statements like, “Shall we wait to do the CT scan till this patient has had the blood transfusion?” [what blood? I thought the count was just fine; why are you transfusing for that count? are there some symptoms I haven't heard about?] “I have to go talk to this patient’s family about discharging them to a nursing home tomorrow.” [nursing home? they're on the verge of sepsis; who said we could discharge them?] “This patient’s pain is not controlled on a fentanyl drip, what shall we do?” [how did they get on a fentanyl drip, and at that rate? how about some non-narcotic medications?] “I’m going to get a consent for a trach and peg on this patient.” [oh, nice; I thought we were going to extubate them in a few days; what went wrong?] And this kind of conversation ought not to be happening; I ought to know, and if I can’t find out for myself, I ought at least to keep close enough track of the interns that they tell me these things sooner. If I could stop running my hands through my hair when three people talk to me at once, perhaps it would encourage the interns to tell me things more.
On the plus side, I got to supervise a couple of procedures today, lines and chest tubes, and was able to refrain from saying too much, and then was able to complete things correctly when the interns stumbled. Which was reassuring to all concerned.
My sickest patient didn’t die overnight, which was a very nice thing to discover in the morning. That’s one ray of light for the day – he’s still around, still worrying all of us to pieces; but at least he’s there to be worried about.