A Budding Emergencist
Thursday, August 03, 2006
  Letting my Idol down
I did two 12 hour shifts with my idol, CHIEF RESIDENT last weekend, and last night his swing shift partially coincided with mine. Some of my illusions were dashed when I overheard him saying, you know on Saturday I had 22 patients and on Sunday I had 25. That's way too much for a resident. With kind of a numb regret, or horror, I realized that I, on the same shifts, covering the same patients, had seen 7 or 8 each night. I had no idea of the lopsidedness of this equation, even grumbling to myself when, flushed with New Doctor Discovering His Value, he would tell me that he had assigned me a new patient. Grr, I thought, I'm working hard, can't he see that? I'll pick up a new patient when I'm good and ready. Little do I know.

The last two shifts, I humped hard, spurred by CHIEF RESIDENT's admonition that interns should see 10-12 patients per 12-hour shift. I was already working as hard as I could, I thought. Much of my time was spend figuring out how things were done, like how you have to order oral contrast separately if you order a gut CT, or worse, how I am still mystified by the computer's admission procedure, wasting my precious minutes and those of residents asking for help. I console myself, thinking, well, you'll learn to run those computer gears until they hum. I console myself, because I know eventually pressure for THROUGHPUT will eat away at time I use consoling, explaining, and cajoling patients into, through, and and after their ED visits.

I think of the time that I didn't take explaining to a kindly 61 year old postman, who I had seen 2 shifts earlier in the ER, returning with the same problem, urinary retention (which I ultimately discovered was due to not BPH or some horrible abdominal pathology, but just a stupid stone), now with an uncomfortable leg bag an indwelling foley penis catheter, placed by my idol, CHIEF RESIDENT, in a misguided attempt to avoid uremia, while not getting the test that would have simplified everything, a CT abdo) and his darling, caring wife, about his uric acid kidney stones and how to avoid them, because that's for his primary medical doctor, isn't it? Only, this couple is new to the medical game and is UNCLEAR ON THE CONCEPT of private physicians for people with good insurance, and gov't insurance is superb. So he will go to whatever shmuck intern will see him in the clinic, waiting patiently in the stinky waiting area for hours, and may or may not be explained to about avoiding further stones by hydrating and alkalinizing his urine.

I could've explained it to him, he was incredibly healthy and intelligent compared to the normal potato heads with 4 or 5 chronic diseases like I normally see, but I didn't have the time to look it up, becuase I had just been served up a new patient by CHIEF RESIDENT, and so I gave him some Vicodin, and good luck. I just hope the next Eager New Doctor will have an attending who will go over the previous visit, and give him the explanation he deserves.

Now, simultaneously feeling I let CHIEF RESIDENT down by not seeing enough patients, and upset with him for subjecting my "private" patient to the indignity of an ambulatory walking fire hose up his penis, while his outpatient clinic urology appointment evaporates, and not getting the !@#$!#% CT abdo that I should have gotten during his first visit, I remember that he has two kids to take care of, and a life outside of medicine--he's human. I think, well, maybe he can't be my idol anymore, but that's okay. I'll just listen to my gut more.
 
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Emergency medicine, from the beginning of a new doctor's career.

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Walk softly and carry a big vocabulary. Don't be inhuman. Find and greet God in every person you meet. The patient is the one with the disease. Do not get distracted. Charity begins at home. Do good and be happy. Don't just do something, stand still. Wear sunscreen. Don't get anyone pregnant, and don't go to jail, young man. Budget your luxuries first. You don't know what you don't know. People like learning, they just don't like being taught. When in doubt, go out. When life gives you lemons, make lemonade. Honey attracts more flies than vinegar.

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