Jaded, Redux

A confidante noted that I've gotten sarcastic. It's a weakness of mine, brought out by paperwork, long hours, and stress. On the way in from the parking garage, though, the birds were chirping, the sun was shining, and the helicopter landed right overhead, which, call me crazy, has always reminded me why I love this job.

Intern year, I will yet conquer thee and remain at least somewhat compassionate. But thanks for the reminder, I need it.

Numbers

I saw 155 patients this month, in 21 shifts.

Shifts averaged about 11 hours, so 11 x 21 = 231 hours, give or take, in the department.

That's 0.67 patients per hour.

Slow things are beautiful, too. Turtles, for example. Gorgeous shells. No one complains about how slow the turtles are. They still manage to do everything they need to, right?

Interns Can't Move Meat

'Moving Meat' is a phrase for quick discharges in the ED. It's a prized skill and one that I, the Intern, do not have. Dear God did I have trouble with dispo last night. We're starting off with an orientation month in our program, and I guess I took 'starting slowly' literally to mean 'wait six to eight hours to dispo your patients'. Horrible.

So what? Well, a recent article in slate pointed out that people who are boarded (kept in a bed) in the ED are 4% more likely to die. There is a mortality effect to keeping patients around when they don't need to be there. Not to mention the experience of angst over discharge ruined my whole shift and probably those of my attendings and the nurses.

Why couldn't I send the quadriplegic with a UTI and no fever home? Root cause? I felt sorry for her. What, compassion bad in an MD? Well, feeling sorry for someone isn't compassion, it's pity. And pity kills. Compassion would've been to see her as a capable human being, and if she said she was OK to go home alone and handle her own follow-up and get her own drugs (as she hadn't last time) I should've probably let her. It sure was simpler watching dispo as a student then doing it. Sigh.

Transition, Part 2

Seriously, am I that full of myself? Oh well. I guess I really do have what it takes to be an MD.

Transition

"He saw: this water ran and ran, incessantly it ran, and was nevertheless always there, was always at all times the same and yet new in every moment..." --Siddhartha, Hermann HesseTransition. The day is fast approaching when there will be new initials after my name, when responsibilty for patients is real. And yet that day will be no different than any other day in the particulars. It holds some special significance, but more in the awareness of the destination rather than the steps taken. Haven't I been studying to become a doctor for four years? And will I somehow become a doctor when I start as an intern? Yes, and no. The path is what matters, but the transition points are the source of anxiety.

I have a trick for this. I put myself on the other side in my head, and imagine myself at the end of intern year, a bit more jaded but also more confident, efficient, and still open to learning. Developing my own ideas. The white coat is longer. It is no longer difficult to write a script from lack of practice. Calling in a consult is only occasionally terrifying rather than often or always.

That is the nature of our transitions. We are always who we are and yet always renewing; tomorrow I will be who I am now but I will also be new and what I did today will be gone, yet it will have decided who I am.

The picture above is of the Rio Grande. The river south is flat and placid, often shallow to the point of disappearing, but higher, in the narrow canyons by Taos, it is a deep and raging thing. It is the same river in both places.

Me, MD.