Number one way to win friends and influence people: Tell the attending on rounds that you’re so glad to see a real doctor after dealing with the residents all night. Since they’re the ones controlling your discharge (we won’t talk about pain meds here, since this patient at least wasn’t interested in that), it’s not smart to alienate them all at the same time. I was the only one they saw for the rest of their admission, and I hope they enjoyed it.

By the end of the day, it became clear that one item on the chief’s list was, “Have a talk with Alice.” It wasn’t too bad, all things considered. She managed to tell me three things I’m doing which must be really bugging her, and I agree I need to fix them; and yet she left me with the impression that I’m being about average for an intern this time of year. Ok, that’s nice to know. Much as her management style is starting to annoy me, I still admire her way with patients, and her grip on all the information relating to her patients and her service. I don’t completely like her personality, but I’ll take whatever she hands out if it will teach me to be as good a surgeon as she is.

Our medical student is insanely efficient and dedicated. He’s almost scary, he’s so determined and successful at his goal of behaving almost like an intern. I have to figure out a way to stop him from seeing half my patients in the morning. Actually, what I have to figure out is a way to thank him properly at the end of the rotation, and let him know in a sincere way what a big help he’s being.

The bad part of the day was that the pathology came back on a patient from last week. After removing a portion of his anatomy, the attending had decided that it wasn’t cancer (in spite of having been originally consulted for four scans which all read, “suspicious for cancer,” “cannot rule out carcinoma,” “suggestive of cancer”). So we had assured the patient that it was all over. And today the results came back, not just cancer, but a kind which is practically unsurvivable to any encouraging length of time (less than a year). Not fun at all. For my part, I’m never going to make any promises till I see the path report. Once is enough for this kind of thing.

I’m also discovering that it’s hard to tell patients the things that my superiors say to, when I disagree. Insist that the patient needs to be in the hospital, when all the evidence but one piece says they’re fine, and we’re just going to end up discharging them six hours later; but I have to go be disagreeable and give an AMA (against medical advice) lecture (and then I did indeed discharge them six hours later). Persuade the patient to have a blood transfusion, when some other attendings have just finished handing me a stack of articles about why blood transfusions are evil and ought to be restricted. Calm the family down, when really there are very good reasons for concern, but we haven’t found a good way to tell them yet. I always have a hard time lying, especially on the spur of the moment; and I hate being told to say something that I don’t believe; this feels like lying. Or insisting on nurses doing something that they don’t understand the reason for, when at bottom I completely agree with their resistance. Talking a cancer patient into treatments that neither they nor I see the point of. . . But, of course, I don’t know enough to say infallibly that my misgivings are going to be correct; I know that some day, if I let these feelings make me disobey orders, I’ll get the patients in trouble. The only safe thing, for me and for them, is to do what I’m told, and wait to consider the value questions till I know more.