One of the characteristics of a good surgery resident is being able to have your finger on the pulse of the surgical services – not just keeping up with what’s happening with your own patients over the course of the day (and especially keeping ahead of the chief and the attendings, because it is bad form to be informed by them of something important with your patient), but knowing what else is happening: when the trauma service is being overwhelmed with operative cases, and may need to pull residents from other services to help; whose ORs are running slow, and may end up bumping your attendings; what disasters are being transferred from other hospitals or admitted from the ER; because eventually all those things can add up to you being needed to help cover other services.

As for the surgical floors, there’s a complicated calculus, taking into account the number of patients on a floor, the number of tubes connected to them, the number of days since surgery, whether it’s a surgical or a medical floor, whether it has cardiac monitoring or not, which determines how often one needs to stroll through in order to catch low urine output, tachycardia, uncontrolled pain, persistent nausea, and wound problems. The best senior residents have this down to an art form, and will always just be walking onto the floor as shortness of breath or chest pain reaches crisis proportions, or as the vascular patient’s slow ooze suddenly becomes a squirter.

On the other hand, one can get in trouble this way. Being too good at keeping your ears open means you get involved in problems that aren’t necessarily strictly your responsibility. Like today when I heard the nurse trying to page a resident, who wasn’t even in the hospital, because everyone else on the team was tied up in the OR. I could have let her go through the rest of the coverage algorithm, and maybe eventually arrive at someone who was free to help. But I was standing there; so I took care of it.

About these ads