Monday, November 15, 2004

senior citizen

Today was my first day as Ward Senior. And it was kind of fun. I'm still trying to learn my new role, differentiating my job from that of the interns, and catch up with the five million bajillion sets of rounds that I'm expected to be at every moment of the day. But I find that the biggest difference is that now, when people ask me what I want to do about a patient, it's not just a Socratic exercise or a topic for academic discussion. They actually go ahead and listen to what I say.

So, what are we going to do about this kid?

Well, what I'd like to do is send this lab test, start this med, cut back on his fluids, and get him ready to go home tomorrow morning.

(Starts doing all of those things in an incredibly efficient way)

Oh my god. I have the power of Greyskull.

I mean, obviously, it isn't just all about rounding and me telling people to do stuff while I sit at a desk counting my money. ("Three, four, five...six cents!") As seniors, we're ultimately responsible for all of the patients on the team, so I did have to spend a good deal of time walking around, examining all my kids, talking to the parents, and basically making sure that the story I understood from rounds was actually the real story. Nothing as embarassing as having someone come up to you asking how long we should continue Patient X's antibiotics, only to be caught completely unaware that Patient X was on antibiotics in the first place.

But being the senior is fun. There's more responsibility, there's learning, there's teaching, and sometimes even free food. And the quiet relief in knowing that you have some experience under your belt. Today, we had to tap a kid on the floor who had been tapped literally nine times in the ER, all unsucessfully. It was tricky, and the kid's back had all these little holes up his spine from past attempts, like he was perforated down the middle. And the mom wanted to stay in the room while I was doing the LP. So yes, there was some sweating, but when I finally got that needle in position and that pretty, pretty CSF started draining out, I had to refrain from doing the freaking-out-with-joy dance and just handed those hard-won tubes to the intern, who rushed them off to the lab. I got the tap, helped a patient, avoided being throttled by the mom, and I didn't even have to tube the samples down myself. It's a beautiful life.

Currently reading: About bronchiolitis in preparation for a talk I want to try and give tomorrow.


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