Pieces of the conversation today:

With ID: “You want to move our unstable patient, who is on pressors and requires frequent vent adjustments, to the CT scan [which you know is the hall of death – because if something bad is going to happen, it always happens on the trip to radiology], in order to see whether his fevers a week ago might be due to an intra-abdominal abscess in a patient with no known intra-abdominal pathology, and therefore a vanishingly low pre-test probability of finding anything we would want to act on? No, thank you.” (The attending agreed.)

With one nurse: “If one of my orders is contrary to the established practice of the unit for the last 15 years, it’s ok to tell me that, rather than come up with excuses about it for two days!”

With another nurse, something I would have liked to say, but didn’t: “Thank you for not telling me, three hours after you told the consultants, that my patient has had no urine output for the previous three hours, when you called to ask for help with tachycardia.”

With the other interns, who deferred to me on an arterial line: “So you’ve actually put in more a-lines than I have, just not unsupervised? You’ve done three, and you’ve done four?” Nurses: “This conversation is making us very uncomfortable.” The line went in smoothly, by the way; which was nice, with an audience like that. Note to self: don’t discuss your lack of experience in front of patients or nurses. Does not promote confidence.

With a mother, something I figured wouldn’t make her feel any better, and didn’t say: “Don’t beat yourself up too much about what happened. It’s done, she’ll recover from it, the scar won’t be too prominent or disfiguring. Look down the hall at the critical patients, and give thanks that you’re not there.” It wouldn’t have helped. If she ever realizes how much worse it could have been, I think she might literally break down.

Attending to me: “What were you doing talking to that impossible family member when we were moving the patient to the OR? Number one, it can wait till later, and number two, why were you letting her trap you?” I’m still thinking about that one. It got the family discharged a lot faster, and I’m not good at cutting myself out of awkward conversations. On the other hand, I guess, trying to be a surgeon, I ought to pay more attention when a patient finally moves to the OR.

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