August 20th, 2004

White Coat

Less trouble than some.

"My medical student," he says to me, glancing over his shoulder as he hangs up the phone, "is less trouble than my intern." The IM residents are all at an IM retreat this morning, 07:30-12:30, and I opted not to go - to stay, instead, and write my notes and see my patients so that I can get out on time.
It is important that I get out on time tonight, O Best Beloved, and not because I plan to drive back to my Angel (I left my cell phone in FW this morning, and my new notecards. Poor me. It is important that I get out on time because the Family Medicine residents have invited me to their volleyball party tonight. There will be food, and company, and I will be getting out and doing things rather than sitting in my apartment by myself with my dial-up connection, getting my tail spanked by Keeper Asmodeus (I love Dungeon Keeper 2, but I cannot beat this level) and missing my Angel.

"My medical student is less trouble than my intern."
Things I have learned by overhearing conversations between S and a terribly unsure-of-himself intern on his first ward month as a Real Doctor:
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S has a bad case of CYA syndrome (that's cover-your-tushy, if you didn't know). Every sentence he utters regarding a patient involves "Make sure to document" or "if you got called to court", some days. He had a brush with malpractise once already in his career, I don't know the details, and it's scared him. But I'm not sure I can practise his kind of defensive medicine. And it frightens me that as I begin seriously to face the future I will have as a physician, that I may have to be able to practise defensive medicine. I write careful notes. I try to have a good relationship with my patients (although my ICU transfer gentleman hates everyone; he's a little demented and insists that he was kidnapped to the hospital, despite the life-threatening sepsis that wracked him from a perforated bowel) and I try to do what's best for them, to explain what's going on and why we're doing what we're doing. And it terrifies me that that might not be enough.

All my notes were done, two and a half hours after I came to the hospital. I was leisurely, came in and chatted with patients, saw my gentleman in the transitional unit for a social visit (he's doing much better, and furthermore has graduated from calling me "baby" to calling me "doc". He even told S I was a genius, and he was blessed to have me as his doctor. I went home with a warm heart from that remark.), I explained test results and gave nurses backrubs and spread around the good cheer.
I feel like there is something I should be doing, like I am not busy enough. Without residents and staff and conference eating the first few hours of my day (8-9, morning conference; 9-10, staffing; 12-1, noon conference) I have completed things at least 2 hours ahead of schedule, and I am hoping I have not forgotten anything.
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I signed out, and I was invited to the volleyball party. I want to go, relax, have fun. S stressed me out this morning, with his lists of things to do and check up on and make sure I wrote for this and that and the other and S, it's okay, I did all that yesterday. I've got it under control. The more he worries, the more I worry that I don't have it under control, and the more I find myself wanting to abdicate responsibility to someone else, someone with all the answers. It's too bad that in the end, none of us have all the answers, and the the thousand-item differential for nausea and vomiting has at the bottom of it "idiopathic" or "we don't know why".

This, O Best Beloved, is why we only practice medicine.
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