I think I've said this before, but there was a reason I went into surgery. Early on in your medical career you make a decision on your specialty based on a few simple questions: do you like working in or out of the hospital? do you like clinic? do you like procedures? do you like sitting around for hours on end contemplating the minutiae of a patient's clinical course? My answers would be, of course: in, hate it, love them, color me suicidal.
I was trying to think of what would be an appropriate rating system for the next four weeks. Based on this morning's rounds, the beer system just isn't going to cut it. I don't know how appropriate it would be to rate my day on how suicidal I feel and rating my day by severity of manner of suicide. I could rate my day by how early in the day I begin to feel suicidal, but if most days are like today, they would all start about 15 minutes into rounds.
Let me explain for those not in the medical field: I am working in the medical cardiac care unit. It's an ICU where patients are sent for a higher level of care. In this case, they're patients with some heart issue or other. Most are there following a heart attack requiring an angiogram or major medications to keep them stable. We "pre-round" on our patients - look up all of their labs, vitals signs and find out what happened overnight, so then we can "round" on our patients with the attending - present the patient to the most senior doctor who will then spend the next several minutes giving us some form of teaching based on whatever issues the patient has.
Your rotation can be very good or very bad depending on how painful the attending is during morning rounds. (Our "City of Lights" attending this week has consistently been rated one of the worst by prior EM residents.) Considering I did two years of surgery, I am used to being hazed, belittled, pounded on, berated, and made to feel completely incompetent; sometimes all at once and for the same patient. But, I have to admit that since rounds lasted less than an hour for the most part, you quickly bounced back after saying "Thank you, sir, may I have another?" and went off to the O.R. for further, not-quite-so-public ritualized flogging.
You quickly learned to develop a thick skin, you learned some medicine, and you learned to be prepared for any possible question at all times. Even so, I never felt suicidal after rounds. Maybe it was the anticipation of going to surgery after rounds. Like a nice reward. Beat on me now then we'll go and cut open some people and then we'll both feel all better.
Medicine rounds are different. You sit for hours and listen as the attending pontificates about the latest study, or his feelings on the latest study, or his study based on the other study, etc. Then you go off and do your work. Then there is probably another meeting so that all the residents can get together and talk about their patients and issues related to their patients, and let's pick one of those topics and talk about it for an hour. Then you come back and finish up the work that you started but didn't have time to complete - orders to put in, orders to follow up on, studies to get the results for, doctors to call to confirm/ask about/report to regarding the studies who then give you more orders. If you're lucky, you might get to sit down later in the afternoon and go over everyone again with the team and or attending.
So, to begin: About 30 minutes into the presentation of the first patient on rounds this morning, my fellow ED resident getting pummeled by the attending, I seriously contemplated jamming a pen in my thigh to distract myself from the pain in my head, and in my butt. Honestly, I am not used to sitting in one place for any length of time. Two hours of rounds, followed by an hour of case presentations, followed by another hour of finishing rounds and then it was time to get down to work. If I'd actually known what the plan for each patient was, I would have gotten my orders written more efficiently, but since this attending followed the "House of God" rules and only spoke civilly to his fellow (someone who's graduated from a residency program and is doing specialized training in a field - in this case cardiology) and not to us lowly interns, I didn't know the actual plans for my patient. These were dictated to me by the third year medicine residents who are allowed to speak to the fellow.
And then, after they'd written all of my orders and told me what to follow up on, I was given another patient to follow for the next day. One that had been presented in rounds by the overnight crew. Of course, had I known I was going to pick up that patient I might have paid more attention, but I didn't. Sigh.
Anyway, I have tomorrow off. We have a mandatory 24 hour period of rest once a week. I will be taking call on Wednesday, so we'll see if I pick up any patients, and then I am on overnight call in the hospital on Friday. During my day off, I will try to come up with an appropriate rating system. Until then... we'll call it a three beer day.
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