Wednesday, September 25, 2013

A day in the life of an academic hospitalist.

The other day I came in to round with my team. Two interns, one fourth year medical student and a third year student, too. My senior resident was enjoying a much needed off day so I assumed the role of what we attendings affectionately refer to as "resattending." Whether we like it or not, we wear two hats on those days.

Mostly, I like those days. The work is substantially harder but in a good way. The teaching is hands on and the level of interaction with the most junior members of the team is more intimate. You get exposed to the nitty gritty that is often lost on the more senior people. So this is what was going on with my team the other day.

So I get there and briefly make a game plan with the team for our morning. "Let's see our sickest people first," I said, "then our discharges. Is that cool?" And they all gave me answers in the affirmative. We briefly chatted about the patients slated for departure and then emerged from our team room ready for rounds.

"So our sickest is. . .hmmm.. . who would you all say?"

"My patient is the most acute, I'd say." This is what Erin, my fourth year medical student said quietly.

"Okay," I replied. And off we went.

She was right. That patient wasn't just sick. This patient was sick-sick. And you know? Even though the patient was indeed sick-sick, we saw that patient and did the thing we've been doing all month: communicate with the nurses and each other. We listened to the nurse caring for that patient and let her know what we were concerned about. And that part was good.

Out we went. Half way down the hall. That nurse came and broke right into our circle. "Our patient has become hypotensive and is working harder to breathe. I'm getting a crash cart." That nurse was calm. She pushed a button and firmly summoned others to join her when they had a moment.

And you know what? They did.

And so. We returned to the bedside just like that nurse asked. And everyone moved in quiet concert while that medical student held her patient's hand and explained what was happening while it was happening. No one was hollering or running or acting erratic. Instead, everyone seemed to just respect the urgency of the situation and act accordingly.

That patient could have coded. But didn't. Those nurses were absolutely outstanding. From start to finish. And you know what? When it was all over and that patient had been moved to a higher acuity setting, I took the time to tell the unit director just that. I wrote down names and called them. Because that's the kind of stuff that saves lives.


So that? That was good. But on the flip side, a patient was ill. Critically so--and when that happens, doctors feel angst. Like, if someone takes a turn for the worse first thing in the morning or really abruptly, it feels wrong. And even if you did all that you were supposed to do, some part of it makes you feel like shit. Particularly if you're the primary person on the patient.

So we carried on with our rounds and at some point I noticed this look on Erin (the fourth year medical student's) face. I could see that her waters were troubled and she was doing that thing that good and caring doctors do. Strapping the burden of better onto her back and feeling bothered that she hadn't been able to lug it up to the top of the mountain.

"You feel bad." I looked at her and just blurted it out. "Do you feel like you did something wrong?"

And her face turned red and she just sort of gave this semi-shrug. A very tiny wrinkle furrowed between her eyebrows and her mouth twisted sideways as she tried to express her feelings. And I stayed quiet and let her. I let her talk through the if I coulda-woulda-shouldas that she needed to talk through.

Next, I fought the urge to pat her hand and launch into some soliloquy about how when I was an intern something twenty times more awful happened. Instead, I sat the whole team down and we walked through the event and used the checklist that my mentor and I put together for processing adverse events in the hospital. And you know what? That part was good, too.

That day was long. We had a lot of patients with a lot of things going on and it involved a lot of really challenging things to think about. But we did it. We put our heads together and powered on through.

I was exhausted when I got home. Completely exhausted yet unbelievably fulfilled. That was my day the other day. And, for the most part, that day was really, really good.

Happy Wednesday.

1 comment:

  1. You honor me with your stories of Grady, I'm so glad that these students and patients have you walking beside them. I say "beside" because even though you are a leader, it appears that they feel you are not superior, but fully human, just like them.


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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