Answering to one attending is difficult enough. Answering to three or four at the same time, about the same patients, is extremely tricky (I’m not going to try to explain the structure of this group of attendings; I still haven’t figured out exactly where the power lines are, which is no doubt part of my problem). When discussing any given decision in the patient’s management, the attending you’re currently talking to is liable to take exception, and start asking how that decision came to be made. You never know if he’s just trying to figure out which of his colleagues has taken the greatest interest in the case recently, or which of his colleagues is wrong-headed enough to be pursuing this particular plan. Or perhaps he knows (and you don’t, yet), that whatever you’ve been doing is so completely off-target that none of the other attendings could possibly have approved it, so either you misheard what they said, or you’re doing it entirely on your own; either way, you’re in trouble. Or perhaps his questioning is simply in the time-honored surgical variation of the Socratic method, in which he attempts to shake you off your commitment to a correct answer.

If you’re just doing the wrong thing, and you can figure that out, it’s relatively simple. Then you merely get to figure out why it was wrong, and what to do next. But if it was one of the attending’s colleagues doing something that he thinks was incorrect, and you’re left trying to explain it, the opportunities for committing a faux pas are endless. You could imply that his colleague was right, and he’s wrong to object; you could imply that he’s right, and you never agreed with his colleague, which is a little better, but still disrespectful to the colleague. Or you could inadvertently make plain that despite the apparent importance of the subject (since they’re all asking about it), you really don’t understand the difference between the two plans at all, or the significance of whatever the difference may be.

And the fellows want to know why I’m sometimes reduced to stuttering incoherently during rounds, as my life flashes before my eyes, and I try to pick which one of these equally impossible situations I want to get into, as I try to explain why the patient is on xyz medication. (Catch them ever helping with an explanation, even if they were involved in the decision! As the junior resident, I am perpetually assigned to be the one presenting on ICU rounds, and thus perpetually the one trying to explain myself.)

Some of the attendings are even more devious. We’ll be calmly proceeding with an operation (a setting where I’m usually safe from being questioned about details of ICU management, since it would be too distracting from the case at hand), and the attending starts what seems to be a friendly inquiry into how the rotation is going, and how the ICU is working. Next thing I know, I’ve somehow managed to say something incriminating about the actions of myself or the fellows. . . I ought to have figured out by now that these attendings are far too complex to ask pointlessly friendly questions. . .

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