Okay, now I’m annoyed. I left the hospital at 8:30pm, not because the patients were so sick or I was so busy (although they were and I was), but because the attending took twelve hours to round. I’m telling myself that I’m not upset just by the time of day, but because the time was wasted. I’ve stayed till 8 and 9pm before, and not been too unhappy, because I was doing procedures, or taking care of a patient who seemed too unstable to sign out. But twelve hours rounding?
This is the attending who can be found in the hospital most nights of the week, regardless of the call schedule. This morning we came for sign-in, and he told us about something he’d taken care of overnight. “But you weren’t on call last night. You’re on call tonight.” “Yes, but I was here, taking care of some things.” Um, sure. Today, the night shift nurses had gotten their change of shift report and were ready to discuss their patients, before we finished rounding on some people. Totally insane.
On the bright side, I am now better at putting in brachial and dorsalis pedis arterial lines than I am at radials, better at IJ than at subclavian central lines, and very handy with an emergent chest tube. I skipped half of rounds, taking care of those things. (That encompasses two or three patients who are terminal, and need their families persuaded that it’s ok to withdraw care; two critical head injuries in the ER that needed to be checked on every two hours; a tension pneumothorax that came up out of the blue; an emergent intubation; and a-lines and dobhoffs scattered like pepper and salt all over the unit.) And at the end of all that, I still had a long list of things to be done; I could easily have kept busy until midnight just fixing the feeding tubes, changing vents and checking repeat blood gases, and repeating electrolytes on my patients. That’s what sign-out is for, because this stuff goes on around the clock. So now I have one hour to eat and do anything else – scribble this – before I go to sleep and get ready to start again, with another slow attending, in the morning. At least the attending today has a sense of humor, and doesn’t mind if we crack jokes about his lengthy rounds; the other attendings take themselves much more seriously, and are consequently more difficult to work with, since there’s less legitimate stress relief.
One week. I can do anything for one week, right? And then I won’t be an intern anymore.
(And to be precise, I learned several tricks about chest tube placement; got to do a needle thoracostomy (actually two, just to be sure we did it right); got enough practice to get a dobhoff feeding tube in right on the first try; learned how to calculate how many amps of bicarb are needed to correct a base deficit (wt in kilos x .25 x base deficit = meqs of bicarb; don’t ask me why, I take this attending’s word for it); reviewed what to do for traumatic diabetes insipidus; did a bronchoscopy, and got the best explanation of bronchiolar anatomy I’ve heard yet; changed another whitman patch (basically velcro over an open abdominal wound, used to gradually pull the fascia back together) at the bedside; reviewed inumerable chest xrays, head CTs, and abdominal CTs, and discussed the significance of a wild variety of findings; and had at least six significant discussions with families; and exchanged jokes with an intubated patient (and what kind of a day is it when you feel cheered up by an intubated patient teasing you? unbelievable). Put like that, it was 15 hours very well spent. Until I wrote all that down, I’d forgotten some things that happened in the morning.)
June 21, 2008 at 10:04 pm
Dr Alice,
Thanks for stopping by and leaving me your thoughts. I did indeed beat you to the blogroll punch– I stumbled across your page a couple weeks ago with the “random next” button, and have been interested since.
The Candor and honesty you show are admirable and appreciated by me– I don’t think many people who come through with seriously ill family members realize what a stressful job those who work the ICU have, How tedious it must often seem, and how despite human nature, there needs to be a certain amount of emotional disconnect with the patients.
As for the publication i work for– I agree with your comment about making a big deal out of race simply making the problem worse. It’s often an internal conflict for me– I know the publisher means well– but still i can’t help feeling that thier philosophies in some way contradict my own. I talk about that in some previous post somewhere, i’m sure. But definately– the comics singularly about the kids in the pizza shop doing their pizza thing are far more enjoyable for me than the obligatory race-relations strips required of me by my contract.
You’ve provided for me some singular insight. I look forward to reading more!
July 23, 2008 at 11:24 am
[…] the attending took twelve hours to round. I??™m telling myself that I??™m not upset just by the tihttps://cutonthedottedline.wordpress.com/2008/06/21/running-at-a-snails-pace/Dorsalis pedis artery – definition of Dorsalis pedis artery by the …Definition of dorsalis pedis […]