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It kept repeating itself in my mind on the drive home the other night: I am an asshole.
There I was earlier, on the phone. I'd been on hold, talking to my attending, and then suddenly there was a live voice on the other end. "Hello, this is Marcus calling from the E/R," I said, "I wanted to see if you drew labs on a patient who was there for dialysis today."
"Okay, I'll check." click - I'm on hold again.
"She's telepathic. How about that?" I thought.
Two seconds later, click "Ah, what is the patient's name?"
I grinned to myself and told her. click -- hold again.
"Nope, no labs. Is there anything else I can help you with?"
"Yeah. Is it standard policy for dialysis staff to ignore that a patient has been vomiting non-stop for the past five days? I mean, do you always just blow them off and send them to the E/R when they're done?"
My attending winced, but said nothing.
Pause, taken aback but still polite, "I don't really know Doctor; I'm just the receptionist. Would you like me to get the dialysis nurse?"
"Omigod, no. I'm sorry. No. Nevermind, I'll handle it. I apologize. Good-bye."
The attending looked at me in horror. "I'm not sure what that was about, but whatever it was, that was the wrong way to handle it."
"I know. That's why I apologized and hung up. I don't know what I was thinking; it wasn't her fault. Good Christ, I'm an asshole."
The attending judiciously said nothing.
The patient was a lady with end-stage renal disease, on dialysis. She'd been in the E/R the day before, as my patient. When she returned the following day, she asked for me, and since I was there, she got what she asked for.
"It's just so nice to see a friendly face," she said, "the nurse told me that you wouldn't stay friendly for long, but that it's still early in your internship. I'm just glad to be seeing a doctor who's nice and cares about his patients."
Somewhere inside, I blew a fuse. Actually, it had blown when the nurse brought the chart over to me saying, "This one is for you."
I had read the name and complaint and seen red. "What the hell is this? I saw this lady yesterday, and told her to have her primary doctor take care of it when she went to dialysis. Why the hell is she back here? This is totally inappropriate. Why didn't someone address her problem this morning?"
Of course it didn't occur to me that she might not have mentioned it to anyone in the dialysis center. All I knew was that we were getting slammed, and that I had too many patients on my plate already. There was a suture-job I needed to take care of, a pelvic exam and ultrasound I needed to do, a patient I needed to write discharge instructions for, and one I was waiting to get labs back on. I was already compromising patient care by making folks wait longer than they should, and now this which someone else should have taken care of.
I didn't know what to do. Call her private physician to ask what gives? --Yeah, right. I was clueless. I wrote her for an anti-nausea suppository, and went back to work. It didn't even occur to me to draw labs. Fortunately, the drug I gave her makes for sleepy, so she rested comfortably while I ignored her. After my appalling debacle on the phone before my attending, who I had been working desperately hard to impress because he's such a good emergency doc and I wanted him to teach me shit, I finally got her in the pipe for definitive management. I got the requisite labs and saw that they were okay. I made sure she could keep a little bit of food down. Finally, I wrote her a script for a good anti-nausea drug and sent her home with instructions to follow up with her primary doctor first thing in the morning so she could get the problem addressed for real.
I still felt like an asshole for taking it out on the poor receptionist.
But that's behind me now; because as of two days ago, I'm Surgery Boy. As the calendar changes, so does my job. Gone are the khaki's topped with a natty green scrub shirt or a stylish mock-turtleneck. Now I troop around in graffitti'ed Nike sneakers and pale blue scrubs. I have filled my pockets with dozens of little surgery pocket references and notecards: one laughing notecard of love for each patient on the service. Verily, my pockets bulge with bits and pieces of ectopic brain-tissue.
There were three of us rounding on my first day of service: me, the chief and the third-year medical student. The chief asked, "So when was the last time you did surgery?"
"About a year and a half back, I'd say."
"Oh marvelous. So basically I've got two third-year students on service."
"Bingo - except one of them has been here for a month and knows the drill, and the other one is utterly clueless," I said smiling.
The chief grinned back, and the student puffed out his chest in pride. He took it a little bit too seriously though - the rest of the day he kept telling me, "Good job," or, "Could you check that for me?"
The first time he asked me to check on something, I gave him a strange look, but did it anyhow. After all, I had intended to have a look anyhow, but was going to ask him to look first and tell me what he thought. But apparently he figured I really was another student, and a rather slow one at that.
"Eh, it's a wash anyhow. He's off service tomorrow," I thought. "Seems like a nice enough guy, but doesn't quite have the drill down yet. The general surgery service will fix him soon enough..."
Five o'clock rolled around, and I was on my own.
Dramatic music played in my head. "Surgery-boy Takes Call," said the marquis in my mind. "O shit, I'm meat." The music changed to a requiem.
I was cross-covering some of the "special" services, e.g. plastics, urology, vascular and transplant. That means that when some sanctimonious fool comes to the E/R with a gash in his face and says, "I want a plastic surgeon to fix me," he gets me. When Mrs. Corndish's fem-pop bypass starts leaking on the floor and she gets a hematoma the size of cantaloupe, I'm the first one on the scene.
Rapture.
Fortunately, I have backup. There are lot's of folks I can call for help, and they're pretty cool about providing guidance. Still, it was unnerving.
The first time the pager went off, I felt important. "Hmm, okay - does he have any sort of kidney problems? No? Well then let's put twenty mil-equivalents of potassium in his lactated ringers. Thanks for calling."
The fifteenth or twentieth time it went off, I felt injured. Ouch.
Evidently the Gods were smiling on me, for I survived the night without killing anyone. I didn't even get any calls to ream me out for something I had done as I was making my morning rounds at five a.m. Wonders may never cease.
After I had seen Mrs. MacTavish, I grabbed her chart to write a note. The student had been there before me, and was just getting ready to take off for another part of the floor. "Hang on a second dude," I told him, "You need to go back and see her again."
"Really - why?"
"Because her lungs are not clear, not even a little bit, and she does in fact have bowel sounds."
"Are you sure?"
"Jeepers, no," I thought. "Yeah, I'm really, really sure. When you present her to the chief, do not tell him what you have written in your note. It's just wrong, and he'll hang you for it. Go back and listen again."
"Oh."
So tomorrow I take call again. Wheee.
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