I learned something from Brad, without quite knowing when or how it happened. Funny, it didn’t really come out till the end of the month. But the last night, and today, I found myself jumping into emergencies, being asked for help, knowing some semi-useful things to do, and being in control of the situation. That’s how I wanted to be; that’s what I’ve always admired about surgery residents, and what I thought, for the last few months, I could never achieve.

I forget which one of the medbloggers described “the kind of doctor who runs towards a crisis, rather than looking for someone else to take care of it.” I still need to learn a lot more, so that I can have more correct things to do. But Brad showed me, more vividly than anyone else this year, how to accept that as the doctor, you’re the one with the answers; if you can’t fix it, there’s no one else who can; so you can’t give up, ever. One night I watched him spend three hours in the middle of a circus of seven nurses and two fellows, with supplies strewn all over the room and an xray team standing in the hallway because we were paging them so often, working on a patient with a blood pressure of 45/– and occasional desaturations. Your heart is supposed to stop from exhaustion and ischemia, somewhere around there. But Brad and this patient – who was quite a fighter himself, staying conscious through this whole thing – just didn’t quit. Three pressors, four, five (that’s all there are), all maxed out, liters of fluid, blood – he kept throwing things in there until the guy finally responded, and pulled through the night. Never give up.

(Of course, today that attitude got me in kind of an argument with some medical consultants on a patient who’s been in the critical care unit for more than a month. He’d just had another operation, and in the OR we had discussed the plan for him: keep waiting, use some more temporizing measures, and eventually – whenever that is – the wounds will start to heal, and he’ll get better. We hope. The consultants were disgusted: we were looking at the short term, we weren’t taking into consideration the guy’s pressor requirements, oxygen demand, etc. I gave up on the argument for peace’ sake; but you can’t give up on these patients without a big fight. I used to think that a lot of the patients you see in a modern ICU – horrible injuries or diseases, ventilated for weeks or months, septic over and over again – are just hopeless, and ought to be let go much sooner. But I’ve seen people, just in the last few months, recover from things you would have thought impossible. They come back months later with a minor problem, and the ICU staff just stares in amazement, to see them walking and talking. There are a lot fewer hopeless situations than you might think.)

I actually miss night float: alone in the hospital at night with all those patients, knowing almost everything that was happening in the hospital. The last night, I knew I’d passed some kind of milestone, because Brad started giving me advice, not about how to be an intern, but about how to handle night float as the senior resident, when I’ll be in charge at night next year.

Advertisements