Today was kind of bad. 16 patients to see in less than two hours; I just barely managed to see them, certainly not to write notes in their chart. So I wasn’t completely prepared to talk with the chief. Then, while I was struggling to catch up, a medical attending paged me to tell me a number of things that were wrong with one of my patients that he was consulted on, ranging from slightly abnormal electrolytes, to a funky coag abnormality that I should have noticed, to the fact that she was having extreme difficulty breathing.

I went to see her, and she was gasping for air on full face mask oxygen, and begging me not to leave her and not to let anything happen to her. Did not make me happy. I started asking the nurses to get a CPAP machine, but apparently that can only be done in the ICU. So between us arguing about whether she could or could not get CPAP right now, pending an ICU transfer, and her being very anxious and obviously dyspneic, the nurses called an almost-code status, and I didn’t stop them. It did make me feel better to have the hospitalist show up and order people around. It also succeeded in producing a CPAP machine and an ICU bed very quickly.

The attending was not thrilled with this management, and I was ashamed of myself. Her cardiac status was fine throughout, she was maintaining her airway, all she needed was CPAP. I shouldn’t have let myself get stampeded into the almost-code, and then let the reins go to a medicine person. The end result was right, even if the attending didn’t like it, but I shouldn’t have let myself be so bothered by the patient’s panic. Hand-holding doesn’t do anybody any good.

The day just went on downhill from there. One admission after another from there, one patient after another developing serious issues. I was running all day and am still wondering what I missed, what I forgot to do, and who will be in the ICU tomorrow as a result of my oversights.

Seventeen patients to see tomorrow morning. . .

One of the junior residents, bless his heart, noticed me being in the hospital at 4am all the time, and I think he told the rest of my team to help out more; which is nice of him to be concerned about me, regardless of whether my seniors do as he asked. I like them, anyway. I need to be pushed, it’s the only way I’m going to get stronger. Hand-holding between residents doesn’t do much good either. The chief observed to the attending that she’s been called intimidating, and he asked indignantly what the problem was with that. I think she just has a more forceful manner than some female surgeons; I’m never going to be that forceful, but she has an absolutely magnificent bedside manner. Her patients adore her – her, not just the attending, although she never claims any status other than a resident under them. She sympathizes with them, gains their confidence, and acts decisively, and they know that she’s taking good care of them.

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