Further installments of the medicine/surgery disconnect:
After a lengthy discussion in the OR about one of our patients who seems to be drifting along, securely not dead, but not making any noticeable progress towards getting out of the ICU, a few of the interns decided to talk to the medicine attending (who is very approachable; it’s not just any attending that interns could consider offering suggestions to). He listened very politely to our (perhaps wild) ideas about changing some of the medications around, and then answered (and I quote): “What he’s on certainly isn’t doing a whole lot of good. But it’s what’s classically indicated for his diagnosis, and I’m not excited about trying anything else. We’ll just leave things as they are.” Which was a very definite close to the conversation.
And we were left to meditate on the fact that almost any surgery attending, faced with three weeks of unsuccessful therapy, would be quite happy to start ignoring the book and branching out, on the grounds that since what we were doing wasn’t helping, some alternatives certainly couldn’t do much worse. Whatever the options might be, sitting still is not a popular one with surgeons.
Who knows. Perhaps we’re just directing our frustration with the patient’s non-improvement towards the medicine attending. Perhaps we had no idea what we were talking about (where’s The ICU Book gotten to?). Or perhaps it’s another true indication of completely different ways of thinking about problems. I wonder whether men and women think more or less differently than surgeons and internists (which is stronger, learned or instinctive behavior – or are both of these differences inborn?). Opinions, anyone?
(But nothing could really spoil the delightful prospect of a whole weekend off – two days in which not to wake up to an alarm clock or get called in the middle of the night.)