Monthly Archives: July 2011

The date wheel rolls over to “thirty-one,” but I know this is wrong. Twisting the stem of my watch ahead one stop, it lands on “one.” A year has passed, it is again July the first, and I am no longer an apprentice at this trade of medicine, but perhaps, a journeyman with still a long sail ahead. When I left my first training waters, I wasn’t sure what to expect of the sea: the great, vast body of bodies filled with pain and suffering and fractured dreams of a better life. My intern year was less a safe, quiet harbor for learning balanced with occasional challenges and more a constant, recurring blockade run of defiance against the forces superior in number that conspire to prevent me from providing what I believe to be the best care I can provide for my patient. The nurse who refused to give pain medication to a person with a history of drug abuse or who concocted a new “policy” that obstructed a doctor’s request. The phlebotomist who ignored requests for stat lab draws off the normal lab draw schedule, be they blood cultures in a patient progressing to sepsis or cardiac enzymes in another showing the first signs of a non-ST elevation myocardial infarction. The consultant who answered each consult request with a barrage of demeaning questions. The resident or nurse practitioner or physician assistant who constantly punted patients to other services to avoid having to address the dreaded task of “disposition,” transitioning patients out of the hospital and toward home. And those who delivered the scores of number pages each day that interrupt important conversations with patients and providers and the flow of patient care, with intentions skewed toward the ability to document “MD Notified.” I left the year worn and battle hardened, trusting few but myself and the men and women who fought beside me every day in these unforgiving waters.

A year has passed, and I have been promoted. I earn better pay, my name is emblazoned across my jacket, and I have a new stripe to indicate my rank. I am now a second year officer of the House, and I have started this new assignment with one young officer to supervise: a first year, an intern. Admittedly, this is a cushier assignment than those assumed by many of my comrades in officer training: the hours are still long, but these western waters are calmer, these crews more experienced and seaworthy. I have new responsibilities: whereas last year I theoretically was always supervised in person, I now command respect as an officer and representative of Her Majesty’s fleet (Her Majesty, of course, being the Queen of medical disciplines, Neurology), and I often stand alone. I received the first call from the port master, the Emergency Room, as word of a distressed vessel traveled with the frantic hum of the helicopter blades. Upon arrival, I was immediately notified and was at the bedside in minutes with the attending physician speaking directly to me and asking for my recommendations as I stepped into the crowded room with eyes turning to me: “Where would you (Neurosurgery) like the blood pressure? We were planning to go to the CT scanner immediately; do you want a plain CT or a CT angiogram?” A member of the Emergency team recognized me and called me amiably by name. It has only been a few weeks, but I have a name, a reputation. Immediately a voice from within relayed, “Keep the systolic blood pressure under 130. We usually use Nicardipine. I would like a CT angiogram of the Head.” A handful of times in the past I have been involved in time-sensitive critical care, including in cardiac arrest codes, but often as the ensign delivering chest compressions or running to the phone to call for more specialized help. But now, the bridge is yours. Although ultimately my attending, my captain, was the primary force steering this ship through the storm of blood and steel and electricity, I was everywhere: by the bedside monitoring the patient’s condition and teaching apprentices, in the scanner control room identifying the aneurysm, coordinating the collection of supplies for a ventriculostomy, sending in my crewman to place the drain (knowing this was his chance to learn and shine), speaking with family about the upcoming procedures and the hard road ahead, and signing out to nurses and doctors in the ICU as we pulled into dry dock and out of the fire and rain. At each step, each individual performed admirably, and I was there to see it all, there to direct and guide and encourage and compliment.

I have a name. I have a command, however modest, and a role to fill in service of the Queen, of Neurology, and of the men and women of her domain whose suffering I can alleviate. I have a responsibility to not be that consultant belittling those without specialized knowledge or that physician recklessly dispersing patients rather than seeing assignments through to the end. I have a junior officer who is eager to break the rules to continue to serve and be at the front lines, and I have an obligation as his commanding officer to protect and guide him, to use him where he can be most effective and gain the most experience and not waste his skill and energy on tasks another officer might feel himself too senior or superior to perform. I accept this new assignment. I am a resident.

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