The service slowed down a little today, and I was able to spend some time catching up and taking care of details. Which was good, because every time I went through the floor I found another patient with issues that neither I nor the nurses had recognized before. I’m frustrated with myself, because I ought to be catching this stuff the first time through, but I’m also frustrated with the nurses, because it’s part of their job to tell me about stuff like this. But I’m no good at telling nurses to do something better, so I usually don’t even try to blame them for anything. I just make resolutions to be more attentive.

I had one patient out of the blue start telling me I was a great doctor, and could he come to my office when I was done training? I couldn’t believe how sweet he was. So encouraging. And his wife spontaneously caught me in the hallway, without having heard that conversation, to say the same thing. Unfortunately, although it’s nice to have the patients like me, it’s no proof of confidence, so I can’t enjoy it too much.

I’ve decided that I’m good at taking care of details (checking all medications, writing absolutely every order the patient needs, changing everybody’s wound dressings, arranging social issues for everyone), and I’m good at taking care of urgent issues quickly (questionable arrhythmias, low urine output, low blood pressure, bleeding, shortness of breath). I’m just not good at taking care of details and emergencies at the same time. I’m trying to make sure one patient is entirely in order, and before I finish my train of thought, five other people want something urgently. I take care of them, and then I forget to finish what I started. If I’m going to do any good next year, I need to learn how to take care of details faster, and to handle details at the same time as emergencies.

One of the other residents taught me to float a Swan-Ganz catheter today, with the encouraging comment that “you’ll need to know how to do this when you’re on call next year” (meaning in a month). (A Swan-Ganz is a small flexible catheter with multiple ports which enable it to measure central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and cardiac output, making it valuable for assesing cardiac status and fluid status in a critically ill patient. It’s fallen out of favor lately, and isn’t used as much as it was five years ago, so I never got to do one before; but when you need it, you really need it. It’s floated, because the method is to get it into the venous bloodstream, then inflate a tiny balloon on the end, which floats with the current of the blood till it gets through the right heart and wedges up in a pulmonary capillary – voila. The trick is to keep the ballon inflated when inserting, and deflated when withdrawing, and to be able to interpret the waveforms that tell you what part of the cardiac anatomy you’ve gotten to.)

And yes, this episode means another one of our patients is in trouble. Our consultants are starting to make very cutting remarks, quite politely, about our complications lately. Thing is, I’m not sure what we could do differently. It’s not as though the same thing is happening to everyone; it’s just that every separate thing that could go wrong, does, for at least one patient every day.

One day left, and then on to the last month of internship. . .

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