Somewhat better today. We had conference literally all morning; which was ok, because I’ve worked out an efficient way to sleep during lecture without amusing the residents and annoying the attendings by nodding visibly. (Back wall works wonders.) Neurosurgery has combined teaching with neurology; I remember why I didn’t want to do neurology, or ENT. (Although how one can look at a diagram of the inner ear, with all those delicate structures intertwined, and all the complex nerve signals which combine to let us walk and see, and not believe in the Creator, escapes me.)

My basic problem is I’m too helpful. I’m too happy to be semi-competent at doing things in the ICU to avoid work fast enough when the residents start dumping on me. It’s only after they’ve walked off (to do something else – these guys are the busiest people I’ve ever seen) that I remember that I’ve now got two extra lists of work, in addition to my own basic list. In spite of that, I got out before 6, which was an improvement. The main thing was that my patients all improved, got off their drips, and remained alert and oriented, so they could leave the ICU – to their delight. Our ICU is of the old-fashioned, open ward, flimsy curtain design. I hate that. It drives all the patients who aren’t intubated crazy, interrupts the family’s visiting hours, and essentially destroys any privacy. At least glass walls are solid.

We withdrew care on a patient today, and of course they dumped the DNR and comfort care orders on me. I wrote them in the corner while watching the family crying and praying with a minister. Somehow, it wasn’t so bad just examining the patient, seeing him lying there, looking at his hopeless labs and CTs. It felt like he was already effectively gone. But seeing the family mourning makes the patient much more of a real person – after all, I’ve never seen him conscious – and his loss much worse.