the underwear drawer

hierarchy
 
The air conditioner in our bedroom finally gave out last night.  It had been making these pained groaning sounds for a week or so now, but seemed to be responding to the well-placed kicks and turn-it-off-then-turn-it-on-again fixit method that I apply to all electronics.  But now it's really dead.  The maintenance man from the building says the motor needs to be replaced. 
 
Damn, it's hot in there.  Maybe we should sleep in the living room tonight. 

*          *          * 

The medical hierarchy is such a ridiculous thing, and so counterproductive to getting things done sometimes.  The chain of command and communication from nurse to intern to resident to fellow to attending and back (though not always ranked in that order) is like this ridiculous game of telephone.  It ensures that the delay from the moment a decision is made to the actualization of that decision is at least two or three hours, if not more.  Sometimes even answering the simplest questions can take the entire day.
 

PEDS RESIDENT

(On the phone)

Hi, I'm just calling to see if the decision was finally made to put [patient] on the surgery add-on schedule.  Do you know if she's going to go down today?

 

SURGERY INTERN

Um, I don't really know.  I have to ask my fellow.  Can I call you back?

 

PEDS RESIDENT

Sure, just be sure you do, though, because I'll need to make the patient NPO and start her on fluids if she is going down.

 

(Three hours later)

 

PEDS RESIDENT

Did you hear back from your fellow yet?  Is [patient] on the list?

 

SURGERY INTERN

Uh, I still don't know, we didn't get a chance to round on her yet.  Can I call you after we've rounded?

 

PEDS RESIDENT

Can you just ask your fellow now?  I mean, he's standing right there.  It's just a quick thing.  Is she going down for surgery today or not?

 

SURGERY INTERN

I'll tell you after we round.

 

(Two hours later)

 

SURGERY INTERN

So I asked, and the fellow has to discuss it with the attending before the decision can be made.

 

PEDS RESIDENT

OK, so when's the attending going to make the decision?

 

SURGERY INTERN

He's giving a talk today at [Upper East Side Affiliate Hospital].  So he won't be back here until 5pm.  But he's going to round with the fellow then and they'll decide.

 

PEDS RESIDENT

Five o'clock?

 

(Four hours later)

 

PEDS RESIDENT

So, what's the good news?

 

SURGERY INTERN

My fellow said it was too late to put her on the add-on schedule for today.  They're going to rediscuss tomorrow.

 

PEDS RESIDENT

What's there to discuss?  Can we just put her on the list for tomorrow morning?

 

SURGERY INTERN

The attending coverage is switching tomorrow, so we need to re-evaluate and the senior resident needs to discuss with the fellow who needs to discuss with the attending whether or not she's a suitable operative candidate.

 

PEDS RESIDENT

But we already decided that she was suitable!  You guys already decided she was suitable!  She was just waiting for a spot on the schedule!

 

SURGERY INTERN

Yeah, but...we need to decide again.

 

PEDS RESIDENT

Excuse me, I have to kill myself now. 

(Does.)

 

 

I know that the layers of hierarchy serves as a sort of a screening mechanism to ensure that the more important you are, the less you have to deal with the piddling bullshit.  That's why the attendings are making decisions from on high and the interns are running around faxing things to the Medicaid office.  But just you wait.  One of these days, I, a puny Peds resident, am going to directly page one of the Neurosurgery attendings for a consult in the ER, and the whole universe will implode with the impossiblity of it all.

Currently reading: "House of Leaves."  I admire the amount of work that was put into creating this book, but it does take an aggressive reader to get through it.

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