In one day, I managed to get two people in the unit I started working in to hug me; got one person to yell at me; got three attendings to call me by my first name without reminders; and put in two Swans (as much as in the previous year together). If I can get these to balance out, the next month might not be too bad. (Although I was starting to get that uncomfortable vibe that becomes so familiar to residents, where on the first day of the month all of the attendings claim to be delighted to have you around, and foretell plenty of hands-on learning, whereas within a few days it becomes obvious that you’re still only a scut monkey.)

Yesterday I also had the biggest fight I’ve ever had with a nurse. Previously, when people say I don’t get along with nurses, I’ve been puzzled. This one was not puzzling. My patients were falling apart. I was moving somebody to the ICU every hour or two, without having the time to stop and think about why exactly they were deteriorating (which makes me extremely nervous and snappy) and there were consults from the beginning of the night still waiting to be seen, and major procedures waiting to be done – and the nurse was trying to quiz me about why I’d decided to do this and not that. I tried explaining nicely, I tried telling her I’d cleared it with my attending, I tried offering to discuss it with any other doctor in the unit whose toes she thought I might be stepping on, but she wouldn’t stop harassing me. Eventually I turned my back on her and told her I was done talking (after she’d carried the argument into the room of a conscious patient whom I was trying to assess for a pressure of 80/40 on pressors). After she finally left, the other nurses in the area had a few rude words for her communication methods, so I know I wasn’t the only one feeling annoyed and frustrated.

I’ve mentioned before how some of the senior residents tease me about doing procedures at the drop of a hat. It’s been a while since I acted like that. Lately, working nights, I’ve been so tired and frustrated that I’ve avoided procedures as much as I can. But in the last 24 hours it all started coming back, I think related to being now responsible for only one ICU instead of four (and thus not having to fear what could happen in a distant corner while I’m tied up in a sterile field), and that the most acute ICU in the hospital (cardiothoracic), where there’s no time or leisure for avoiding lines and tubes. I’m reacquiring my knack with sharp objects, and it feels good; surgeons are supposed to be comfortable moving quickly with knives and needles. When I was avoiding procedures, I felt an uncomfortable camaraderie with the naval captains in Patrick O’Brian’s books, questioning their courage when they decided it was wisest to avoid an engagement with the enemy – but not any more.