Exit Interview
Tamra Travers ~
Eye-Opener
Daniel Lee ~
1. Bipolar disorder
2. History of postpartum psychosis
3. No custody of her children
4. In treatment for cocaine abuse
5. Regular smoker
I digest each of these facts on the computer screen in rapid succession, progressively cementing the picture of Renee Pryce, a twenty-eight-year-old woman in her final months of pregnancy.
I’m a first-year resident in a large urban county hospital. In the course of my training, I’ve learned that some people (mostly older doctors) find the electronic medical record (EMR) burdensome and inefficient.
On Being a Lady and a Doctor
Caitlin Bass ~
It’s 8:00 pm, and it’s hour fourteen in my twenty-eight-hour call shift at the large suburban hospital where I’m an intern.
You demand to speak with a doctor now, right now. You cannot wait. Your mother is sick, and you want to know exactly what is going on.
It doesn’t matter that we already spoke at length by phone earlier this afternoon. It doesn’t matter that it’s 8:00 pm. It doesn’t matter that I don’t have any updates to give you.
You’re here, and you want to speak with a doctor, your mother’s doctor, now, right now.
Luckily for you, that’s me.
Deadlock
Zachary Reese ~
“Does a rock float on water?” I asked the haggard woman lying in the ICU bed.
I was an intern, in the first rotation of my medical residency, and Mrs. Jones had been my ICU team’s patient for the past week. Over that time, she’d looked more and more uncomfortable, constantly gesturing for her breathing tube to be removed.
Mrs. Jones tried to form words in response to my question, but the plastic tube in her mouth prevented it. Her chest rose and fell in rhythm with the ventilator’s hiss as the machine pumped air into her lungs; her muscles were too weak to do the work themselves.
After several attempts at speaking, she gave up
Birthday Boy
Joe Andrie ~
It’s another day for me as an intern on the labor-and-delivery floor of my large urban hospital–another day scrambling to help pregnant women deliver and trying to keep pace with the unpredictable timetable of the birthing process.
My hospital phone rings. I’m really starting to dread that sound.
It’s the triage nurse. We’re admitting a patient: Mrs. Harris, age thirty-four, who’s had several prior deliveries and therefore carries the label “multiparous,” or just “multip.”
Flipping through her records, I see “G5P4” noted. “G” means the number of pregnancies; “P” indicates how many children she has.
A mother of four who’s at term and having contractions…I’ve seen such women give birth within a matter of minutes. In plain
Cri de Coeur
Naderge Pierre ~
As a surgical resident nearing my final year of training, I loved to operate. Whenever I was on call in the trauma unit at our large urban teaching hospital in Washington, DC, I’d yearn for my pager to go off.
I was always tired, too–but for a surgical resident, fatigue is a given. Sleep and eat when you can, get your work done and operate like a madwoman: That was my life. It felt like a high-adrenaline thrill ride, and I was enjoying every swoop and turn.
I never expected that, while racing towards the final exhilarating peak of my training, I would become a patient myself.
Ironically, it happened right after the most memorable surgery of
Family Summons
Startled out of sleep, I reflexively reach for my beeping pager. For a split second, I lie poised between wakefulness and terror in the pitch-dark resident call room, not sure where I am or what happened. I resolve to sleep with the lights on from now on.
I dial the call-back number.
“Pod A,” a caffeinated voice chirps. It’s Candice, one of the nurses.
“Hi. Amy here, returning a page,” I murmur.
“Oh, hi, Dr. Cowan,” she says. “I just wanted to let you know that the family is all here. They’re ready for the meeting.”
Deathbed Epiphany
As a family-practice resident, I’ve found that a premium is placed not only on my clinical acumen but also on how well I respond to my patients’ mental and emotional experience of illness.
Yet the work of learning to be a doctor is just that–work. And in overwhelming amounts. Time management becomes ever more vital: As I take the time needed to gently break bad news and to console a patient, I must also stay conscious of the next patient’s appointment, the next phone call to make, the next exam to study for, the next lecture to attend, the next research project to complete and the next practice guideline to learn.
The Secret
Gabriel Foster
“If my father dies, you’re going down with him.”
The words pierced the air, and suddenly there was silence.
I hadn’t noticed Frank’s son at first. He’d been pacing in the back of the family group gathered in our ICU waiting room. Now, up close, I could appreciate how large and intimidating he was. And I’d just had the thankless job of telling him, along with the rest of his family, a shocking, completely unexpected truth: Frank wasn’t dying, he was already dead.
No Retakes
I was midway through my internal medicine internship when elderly Mrs. Armstrong was transferred to our service for treatment of a pulmonary embolus (aka PE–a blood clot in the lungs) after a knee fracture repair. I remember thinking, disparagingly, “Surgeons should be able to treat a PE!”
The following morning, our team rounded on our patients and hurriedly wrote orders and notes because Susan, my senior resident, and I would be in clinic all afternoon. As we worked, another resident, Greg, stopped by and invited us to a party that evening. “I hope I can come,” I said. “If I finish early enough.”
It Doesn’t Work That Way
My second month of residency. My first solo thoracentesis–a procedure to remove fluid around the lung. The supervising physician I’d just met watches over my shoulder as I carefully count and percuss the rib, fasten the drape in place, gown, glove, and cleaned off the skin.
Infiltrate with lidocaine…good. Thread the catheter into the trochar…good. Attach the stopcock…good. Make sure it’s open in the right direction. Puncture the skin, pull back on the syringe, fill the syringe with fluid. A sigh of relief–it’s in the right place. Turn the stopcock, remove the syringe…. The supervising physician makes an inarticulate noise. I look at the stopcock and freeze. It’s turned the wrong way. I have just introduced air into the area around the lung–a major mistake.
2:00 am
Katie Lin
It’s 2:00 am, and the fluorescent bulbs flicker gently overhead along the quiet hallways of the intensive-care unit.
Tonight I’m the ICU resident on call, and the weight of that title sits heavily on my shoulders. My team is in charge of keeping our critically ill patients safe from harm overnight. Although the supervising physician is only a phone call away, I’m the acting team lead for any codes called during the night on patients elsewhere in the hospital who may need our life-support services. Code Blue: cardiac arrest. Code 66: anything else requiring assistance.
The metronomic beeping of the life-support machines keeps time as I blink the weariness from my eyes and share a few muted smiles with the