I whisper your name (ayradyss) wrote,
I whisper your name
ayradyss

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Thirty seconds.

Walked into my patient's room this morning. "I want to go home," she says. Then she gives me a Look. "Can I talk to you about something, just between you and me?" Of course you can.
She tells me that if Y, the resident who sees patients with me when S is on call, ever dresses her down for stating her wishes again, that she is going to throw him out a window. Apparently, he told her that she had no right to tell the doctors she wished they would just take her thyroid out if that was what they were going to do, accused her of being too emotional, and told her to just relax while she was in the hospital. I would take it with a grain of salt, but I know Y.

Today: He swept in, introduced himself and me before I could even see the patient around the door, and went through a whirlwind of question-answers, never pausing quite long enough for the patient to think. She has nausea and vomiting and diarrhea, has had for two weeks. That's all that matters to him, despite all his lectures to me about getting a good history and asking questions to sort out the differential.
Today: He interrupted another resident's morning report presentation to take up the topic of the anion gap and how vitally important it was to calculate the delta/delta gap in every patient with an anion gap. The patient in question had an anion gap of 13. Normal is 6-10 or 7-16, depending on which page of the bible Harrison's you read. Someone challenged him. He defended his work by pointing out that the delta/delta showed a hidden metabolic alkalosis. There was a whisper beside me. "Well, yeah, she was vomiting." Not so hidden. And again, a lecture on the urine anion gap. Y loves numbers and mnemonics and steps to go through to make sure you've covered every angle.
Somewhere along the line, he missed one: the bedside manner. He irritates me, abrogates the patient's voice, and sweeps through like some sort of mathematical tornado. He gets the right answer, but leaves everyone bristling. I do not ever want to be Y.

And so help me, if I ever have to have a medical student do what I did today, I may hang up my stethoscope and turn in my license in shame. After S left the room of a mid-seventies lady with chest pain, I looked at her. "They told you you're staying overnight, right?" She nods, with the shell-shocked look of the elderly and terrified and confused. "Do you understand what's going on?" She shakes her head. "Or why you're staying?" This is the second patient, O Best Beloved, for whom I have stopped at the bedside and taken thirty freaking seconds to explain why they are going to be admitted. The first was a lady who asked me, shyly, if she could ask a question. "Am I going to be staying here?" The second was today. Thirty seconds: "In women who have chest pain, especially over the age of 45, we worry about their hearts being the cause of it. Women often don't have the usual presentation for heart attacks. We want to keep you overnight, look at your blood for some markers of heart damage, and do a stress test - look at the way your heart uses blood - in the morning. If all that's normal, then you'll go home tomorrow. If something comes back not-normal, we'll call the heart doctors and have them talk to you. Okay?"
She nodded, managed a bit of a smile. "Okay." I looked into her eyes. "Any questions?" There was a pause, for thought, then she shook her head. "No. Thank you, doctor."

Thirty seconds.
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