I was truly angry today, for the first time all year. I’d thought before that I was angry at someone or other; but that wasn’t serious. I came in this morning and discovered that one of the nurses had done something majorly against the rules on one of the patients that I care about intensely, and have been following, as one might say, like a hawk, all month. I was angry. The rest of the team could see the smoke coming out of my ears.

Fortunately, the nurse in question wasn’t there today. I hope I would have behaved if she had been. But it made it simpler not to have her there, because I didn’t have to try to explain in a calm fashion to her what she’d done wrong. Instead, I got to cool down while waiting till the supervisor came in, and then talked to her. She at least sounded as horrified as I had been, and promised to speak to the nurse. Since I’ve only got one more day here, I don’t think I’ll have a chance to talk to her – which is safer, between my anger and my propensity for sticking my foot in my mouth even at the best of times.

I don’t think the patient has been actually hurt, just potentially, and the protocol violated. Another time, it could be serious. This time, thank God, not too much. But this is one patient I don’t want to mess around with (none of them, actually; but this guy is special to me, maybe because he’s been here so long). . . Next time, I need to learn how to be appropriately angry, but not let it throw me off my stride. It took a good deal longer to round, because every time I went through this patient’s data, my mind went back to this problem, and I couldn’t concentrate. (And yes, the medical ICU team is in this mess somewhere; I tried talking to them, but they misunderstand everything I say, in a friendly way, so that nothing short of a flat insult would communicate that I’m really very unhappy with them. They’ve been too friendly for me to want to be downright rude, so I’ve given up on telling them what I think about their lack of communication with the surgery residents.)

Along these lines, the other day I diagnosed something, and bothered the medicine attending until he gave in and agreed to treat it, although he didn’t believe it existed. Evidence the next day proved, to me, that it did exist, and needed to be treated. Now I’m frustrated with myself, because I diagnosed it for the wrong reasons, and wasn’t expecting the evidence that showed up the next day. I was right, but for the wrong reasons, which is no good. I’m also frustrated because the medicine attending blandly ignores the incident, and I can’t tell whether my evidence is convincing to him, or whether he still thinks I’m wrong (and maybe I am, because he is after all an attending). And my attending doesn’t seem to care one way or the other, so I have no confirmation from him.

Tomorrow will be a grand finale, quite exhausting. I’ll be ready to get out of this ring of miscommunications. I’ve spent the month trying to establish a reputation for myself as different from other surgery residents who’ve come through here, and I haven’t succeeded enough to change the nurses’ behavior patterns. They know, even if I’m better than others (which I doubt), I’m only here for one more day. . .