Sorry for the light posting, folks. Life is extremely dull these days.

Which leaves more time to observe the political delicacies of the transplant service. Transplant is unique as a surgical specialty, in that it is a surgical cure for a medical disease. Normally, there’s no surgical role in diabetes, renal failure, or cirrhosis. But once the patient is sick enough to have a transplant, the surgeons and internists have to work together. Very closely.

I don’t know how other places manage it, but nobody has ever defined, here, exactly who is in charge, although everybody agrees that I get to admit and discharge all the patients. There is a great deal of collegial conversation among the attendings (“I trust Dr. Smith, let’s do whatever he says;” “don’t worry about it, I’m sure nephrology/GI/endocrine has it under control”). The residents and fellows also do a fair amount of the same, perhaps a little more barbed (“Good morning, I was just wondering what you thought about. . .” [which being interpreted means, what on earth where you thinking when you did this?])

And then I end up in the pleasant situation of the patient asking me the meaning of a test I didn’t order and had no idea about, or the purpose of a medication I thought he wasn’t supposed to be on. Or better yet, the attending asks me what the immunosuppression is/what the iv fluids are/what the blood pressure medications are, and whatever I tell him is wrong, because someone changed it since I last looked at the chart.

The key seems to be politeness, no matter what you think or are saying, because as long as you say, “what on earth was the point of that?” or “did you not notice this major problem?” in a very polite way, you can keep working together. And I’m sure the nephrology and GI fellows feel the same way about me; perhaps with more justification, because after all, what is a surgery resident doing with these medical patients?

You may perceive that my ambition to know all about medicine has long since vanished. I don’t care about the intricacies of lopressor vs atenolol, or all the possible ways to control blood sugar, or unasyn vs zosyn. It doesn’t need to be cut, I’m not particularly interested.

Bonus: after he counted me coming in at 5:30am for nine days in a row, one of my patients told the attending, when we rounded several hours later, that I was an exemplary doctor and deserved a raise and/or a day off. Makes things worthwhile.

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