Sorry for the shortage of posts. Night float doesn’t leave a lot of energy for talking.
Last year I was in awe of the junior residents on call. So much responsibility, and they handled it so coolly. Sometimes I saw the stress, but they covered it pretty well. I wanted to be like them.
And here I am now; I don’t think I’m as cool as they were. In fact, I can see it, when there are senior residents around at night for other things; they look at me out of the corner of their eye. I’m not doing anything exactly wrong, not wrong enough to be stopped; but I’m more excited/nervous/antsy about all of this than the guys ever let on. (I’m upset that my patients get sick, become permanently handicapped, die, and I can’t stop it; I don’t know how not to be nervous with these things at stake.)
There is one resident who to me is the epitome of a good doctor: he’s very serious, smart, thinks everything through, and is always willing to put in extra hours to make sure that things get done right. I remember him, on night float, staying hours late in the morning to make sure everything was settled. This morning, I was pleased to be able to do the same thing. A patient came in right before everyone’s shift change, seriously ill. Several different surgical services needed to coordinate to get him in the OR. Although everyone agreed that he needed surgery urgently, it was a little more tricky to decide what exactly was wrong with him, or what precise procedure we could do to fix it, or which surgery team ought to start the proceedings. I’m not sure how much I actually contributed; but my attending was the one making the most concerned statements about not losing time; so I stayed, and called the OR to encourage them that even though I couldn’t quite tell them who the surgeons would be or what the exact title of the procedure would be, they needed to get a room and provide certain equipment. And then I stayed with the patient, as other people had to come and go, and got him up to the OR, and explained his problems to anesthesia. (My commitment to patient care did not quite cause me to scrub in; they would have let me, but an unworthy desire to sleep overcame my passion for knowledge. . . or something like that.) It wasn’t a big deal, but I was satisfied that even though I’m not yet as cool and collected as the guys I admired last year, I can go the extra mile too.
And as they say, nobody’s died on my shift. . . so far. So I guess all the other problems are small in comparison to that accomplishment. I must be doing a couple things right.
March 26, 2009 at 11:27 am
I don’t think it’s an “unworthy desire to sleep.” It’s great to take ownership of the patient like you did. However, people also make mistakes and use poor judgement when they’re sleep deprived (e.g., airline pilots, bus drivers, etc.), so it’s honorable to conduct a thorough transfer of care and leave the patient in other capable hands, like you did.
I’d rather have a consciencious and committed physician like you than an excessively nonchalant one any day.
I’m sure the bottle of sevoflurane appreciated hearing about the patient’s medical problems, as would the anesthesiOLOGIST.
March 26, 2009 at 12:25 pm
You Didn’t Stay!!!!!!???????
What are the kids comin to now a days?
So you’re a Surgery Resident and all you did for this patient was “Coordinate”
Just bustin B****s, I thought the 80 hr week was a good idea in 1987…
Anesthesia was sort of the opposite, we’d try to sleep as much On Call to make better use of our free “Post Call” days, and we didn’t use em to read…
Frank
March 27, 2009 at 7:30 am
Sorry Jonathan, you’re right. I don’t think the sevo bottle was listening.
Frank – You’ve heard about the IOM report suggesting a nap after 16 hours on duty? I’m not sure whether to be more worried about Obama’s nationalization schemes, or that piece of idiocy.
March 31, 2009 at 12:01 am
Sorry, Alice, call me old school but I really think that you should have scrubbed in…there is MUCH value in seeing these things out, and, though admirable that you went the “extra mile” in getting the patient to the OR, in real life your job will be getting the patient in and OUT of the OR. I pity you guys in training now (and I’m only 8 years out), it will be a rude awakening when that patient is fully your responsibility.
March 31, 2009 at 8:08 am
I agree, there’s value in seeing the patient’s complete course. My greatest frustration as a junior resident is seeing the patients preoperatively, and different patients postoperatively, but not through the OR. Nevertheless, I’m bound by the rules that are now in place. I just hope they don’t change the rules anymore. We barely get enough experience as it is, and with any more restrictions, I would be scared to graduate from residency.