Events of the day included:

Me deciding to address all the attending’s pet peeves by acting on them before he did. Result, the nurses were mad at me as well as him, and I don’t think I saved much time. It did make the attending happy, though.

Attempted bronchoscopy: Attending: “Sure, you can do it with me. Have you ever done any of these before?” Me: “Yes, definitely. (sotto voce Twice, to be precise.”) Attending: “This is how it’s done, bzzzbtttbzzz (words all blurred together). Ok, go.” So whatever I remembered from the previous two times disappeared, between the attending being not wanting to do it at all, and being in a hurry, and the patient actually having a problem.

For my commenters: Attending: “Anesthesia left the a-line hanging loose again. Suture it in right now.” Me: “Yes, let me find some suture. Um, I once heard a rumor that suturing radial a-lines promotes infection and thrombosis. (Although my literature search showed nothing of the sort.” The attending looked at me as though I had just sprouted an extra head. (Note to self, not to refer to blog commenters anymore unless accompanied by evidence.)

Taught three different people how to place post-pyloric feeding tubes – on the same patient, because every time we got one in, confirmed placement, and start feedings, he’d get it out by yet another method.

And spent all spare minutes trying to adjust the ventilator settings on the sickest patient in the unit, who has all kinds of unusual methods being tried on him, and none of them are working. Only two doctors in the unit really understand his respiratory status, and of course they’re not there all the time. I perhaps flatter myself in thinking that I understand a little of their methods, certainly more than the people who say, “I have no idea why he chose these settings, I don’t understand the rationale at all, let me tweak it a little.” So all day long the people who did have a clue would walk by and laugh bitterly at my blood gases, and inquire why it was taking me all day and I hadn’t done x/y/z obvious thing to correct the glaring abnormalities. Thanks for the help, folks.