Surgical Rounds.

It' s probably going to come as no surprise that lately, I've been a little STRESSED. I'm stressed because I'm overworked, under paid, sleep deprived, on a crappy surgery rotation, but more than that, I'm stressed because my co-intern on this rotation (who is actually a surgical intern) is a ball of nerves. He has been so beaten down by his prior surgical rotation where he worked 100+ hours a week and came in at 3:00am every morning that he EMANATES anxiety and stress. The boy needs some Ativan.

Unfortunately though, his stress is making mine worse. For example, this morning, I updated the patient list, and I put two patients, who are in rooms 043 and 042 at the bottom of the list. Well, unbeknownst to me, the surgeons here have a particular order in which they like to round. They start at one end of the hallway and wrap around to the next one, and so the patients have to be in exactly the same order. But I figured, what's the big deal….I'll just correct it next time.

Not so.

Me: yeah, well, when we start rounds I'll just mention that we need to see 043 and 042 first. *shrugs*
Him: NO. WE CAN'T DO THAT. THEY'LL BE UPSET. WE HAVE TO CHANGE IT. I HAVE TO CHANGE IT. NOW.

(I stare at him blankly)

Him: DR Q HAS THE POWER TO FIRE ME. YOU. THEY LIKE THINGS TO BE PERFECT. IT HAS TO BE PERFECT.

(Dr. Q is this important surgical guy who does NOT have the power to fire me….but in any case, my stress level has already risen about 10 fold in the course of this short conversation)

Me: okok. I'll change the list.

Him: OMG. ROUNDS IS STARTING IN 10 MINUTES. WE HAVE TO HURRY.

So unfortunately, this conversation wasn't as much funny as it was pathetic. Ugh. I just feel so bad for this guy who is being crushed slowly by the wheels of residency. That's how the surgeons remake themselves, by pounding down the new interns and then building them back in their own image. Ugh.

The truth about Q2 call.

They can only get away with it if they say it's "home call".

And if it's "home call" (ie, you can stay home and field calls and consults) they don't have to give you post call day off.

But "home call" is just as bad, if not worse, than in house call when you get called into the hospital for 3 admissions and the nurse calls you repeatedly about a bradycardic (yet asymptomatic) man who has been admitted for a pacemaker placement.

Yes, i know he's bradycardic. no i don't want to do anything about it BECAUSE HE'S GETTING A PACER TOMORROW.

But it's ok... because i just informed the family med dept that i will be going over my 80 hour a week mark. And they will soon be pulling me off this ridiculous Q2 call.

HORRORHORROR.

I have Q2 call for Surgery next month.

I have nothing more to say.

So what if you couldn't eat?

One of my patients is this 62 year old guy who had epiglottal cancer and is now terminal. He's extremely malnourished, G-tube dependent and unable to take anything orally except a little jello. He tried living on his own and failed miserably, and consequently landed in the hospital on our service. So here's this ornery guy who's making the nurse's lives a living hell, who's refusing to take his G-tube feeds because they're "not right", and who went down to the cafeteria to get a cup of parfait and threatened to shove it down his throat.

I went up to talk to him, and I realized that he's difficult because he's scared, and defying doctor's orders is his way of trying to take back control of his life. And he wants to eat because eating is the only thing he has left that gives him pleasure.

So as I was sitting there trying to convince him not to gobble down the parfait, I was thinking in the back of my head, " who CARES? He's going to die a horribly painful death of metastatic cancer, let the guy EAT. I mean, which way is a worse way to go? Aspiration pneumonia or cancer mets to the bone? And he's clearly still mentally competent….he could go eat a steak in front of me and I couldn't do anything about it.

Luckily, the speech and swallow therapist agreed with me, and said he could go enjoy himself, because hey, he's about to kick the bucket anyways. But to be living a life where a basic human instinct, eating, is thwarted is just SAD. When all your nutrition comes from little cans that you pump into your stomach is just sad, sad, sad. Who the hell wants to die like that?

DieDieDie

The (long) white coat. A symbol of responsibility and professionalism.





Hahahaha. I want to BURN IT.