Tuesday, August 10, 2004

long day's journey into night

This is how they like to work it with the ER shifts at my hospital: Monday through Friday, 8am to 6pm. So far so good. Saturday, noon to midnight. Sunday, overnight 8pm to 8am. Getting pretty tired by now. Then, the coup de grace, the 11pm to 8am overnight shift all the following week. To top it all off, at the end of my work bonanza, 11 straight days in the ER without a break, we'll be headed off for a family wedding in Ohio, which may actually be the most tiring part of it all. I hope there's no conga line at the reception, though I know in my heart of hearts that there will be, and I will be unwillingly roped in and perhaps given a maraca or two to shake.

I was looking up some lab results for one of my patients in the ER earlier today when I caught the edge of a conversation between three attendings. I wasn't evesdropping, I just happened to be using the computer, and they happened to be talking loudly right next to me. Rather, one was talking loudly, and the other two were nodding. But some monologues are better conducted at lower decibel range.

Residents these days just aren't the same as in my day.

(Checking patient lab results)

(Voice echoing throughout the ER)
They just don't have any sense of personal responsibility!

(Seeing acute patient, starting them on medication, getting EKG)

(Setting off car alarms outside)
They're just so lazy nowadays!

(Calling IR for the five millionth time to get a patient on the schedule for J-tube placement, running back and forth conferencing with parents)

And forget trusting anything they do or say! Physical exam findings, history, it's all wrong! I mean, you basically have to do everything that they do over again!

(Handing ATTENDING a chart)
Here, I saw this kid, got the history, got the labs, diagnosed her, treated her, talked to the family, and arranged follow up. Just sign right here and I'll discharge them.

(Signing without even loooking)
I mean, it's like I do all the work around here! (Answers ringing phone) No, I said turkey on white! On white! With mustard! What are you, an idiot?

(Maimed by a falling anvil of irony)

First of all, lady, I can hear you. I'm right here.

Second of all, (this is the ruminative part) it's just so funny how medicine is. Of course everyone is working hard, and of course there are people who feel to some degree that they fact that they're working so hard means that other people must not be working hard enough. But enough already with the "Back in my day, residents had to walk uphill both ways to work without shoes in the snow to and place all their own IVs" shtick. Seriously, just give it a rest. The reason that we don't take 48 hour call anymore and single-handedly take care of 50 post-op NICU babies simultaneously and draw all our own bloods on 30 Onc patients' central lines each and every morning by ourselves is because these things sucked. There's nothing romantic about all that, though there is the rosy survivor's afterglow. It sucked and it was cruel and most of all, it was unsafe for the patients. And the fact is that we know better now, because we have more technology and more delegation of scut and more understanding of what is important for patient care and physician education. The Old Way is not necessarily the Right Way.

Do we work fewer hours than the residents of yesteryear? Due to new laws, yes. That's why the laws were made, and why they are enforced by government visits and hefty fines. But are we lazier, stupider, and worse doctors for it? Does it make us care about our patients any less just because we're not there by their bedside for 72 hours straight? Does it mean that residents still don't work their asses off every day of the week, that we don't eat, sleep, and breathe medicine? I doubt it, sister. So cram it with walnuts.

Currently reading: "Beg the Question." It's hard to read comics on the train, people are always peeking over your shoulder. Luckily, this one is somewhat disguised in hardcover.

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