Saturday, August 16, 2008

Getting things done...not always easy

It's been an interesting couple of weeks. Although I'm actually working the same number of hours this month as I did on trauma, I feel much more relaxed. We have been averaging 3 or 4 patients at any given time, so I have just been rounding on 1 or 2 in the morning, then going home around 3 or 4 unless I'm on call. So far nothing terrible has happened on call.

My attending for the first two weeks is very hyperactive and gets bored very easily. He also has a very direct attitude. I actually really like him, he teaches and makes rounds incredibly entertaining. The anesthesia residents, used to lower-key attendings didn't like him at first but are now coming around. The nurses want to kill him, which has made things somewhat awkward. ICU nurses, at least the ones here, are generally very good. They only take care of one or two patients at a time, so they know their patients well. They are used to taking care of very sick patients, so there isn't much that can phase them. The problem is that their comfort levels are often so high that they think they know how to take care of the patient better than anyone else, and they do all they can to get their way. Whenever one of us (residents) gives an order they disagree with, we have to come by every twenty minutes to make sure that it actually gets done, and that they don't "forget" or get "too busy" to do it. There have been several times I've asked them to do something one way, and a couple hours later I'll come back to find that they've done it the way they jolly well pleased. This makes me very irritated--I really respect ICU nurses, and they often know how things work in the ICU better than I do--if they suggest a plan different than mine, more than likely I'll defer. But doing the opposite of what I say without telling me is unacceptable (and technically illegal). There have been a couple occasions when they didn't like what one of the senior residents said, so the paged the fellow over her head, and lied about not having been able to get a hold of the resident. They are usually better when attendings give orders--the problem is, as previously mentioned, they hate my attending with a passion because he actually insists that things be done the way he orders. So their solution is to call the surgeons with questions rather than the ICU team. This leads to the surgeons' ordering things without our knowledge, which leads to bad patient care from a too many cooks in the kitchen standpoint. It has altogether been very frustrating, and puts me far too often in the position of choosing between being undermined by someone who legally and ethically must follow my order, or making an issue of it and becoming hated by the entire ward and subject to all their passive-aggressive maneuvers. So far I've let things slide. I'm not sure how much longer I'll be able to take it. Many of the older nurses don't bother with the passive-aggressive behavior, they just flat out tell us they won't do something (this is actually why they hate my attending--they've told him that a couple times and he's made them do it). I'm just getting so tired of the squinty-eyed-that's-stupid-I'm-not-going-to-say-anything-but-as-soon-as-he-leaves-I'm-doing-it-my-way facial expressions. I think I find it particularly frustrating because I have always made such an effort to treat nurses like colleagues (and despite how this post sounds, I am actually on very good terms with the nurses in the ICU--which in some ways makes it harder).

Sunday, August 03, 2008


I just finished trauma. I am now beginning an ICU month at the local VA hospital. I had my first call night on Friday--it wasn't nearly as bad as I was afraid it would be. All our patients were stable and I was able to deal with all the issues that arose without having to page anyone higher up.

This month is particularly intimidating for me as 1) these patients are much sicker than any patients I have dealt with before and 2) when I am on call I am the only surgery resident in house (as opposed to last month when I had a chief in the hospital with me whom I would run things by ever couple hours) which means I have to page the fellow at home if I have a question about something. On the positive side our patient census is very low (I only had three patients to worry about).

Another negative thing about this month is that it is at the VA. While I think the VA here does provide good patient care, it is, to put it delicately, a "no-frills" kind of place. For example: my main hospital has a couple decent cafeterias, one of which is open 24 hours a day. When I don't get a chance to eat until 10pm, I can still go down and get a hot meal. The VA has a cafeteria that is abysmal (yet more expensive than my main hospital's), and that closes around 4:30pm. On surgery, one doesn't eat dinner by 4:30pm. There is nowhere else to get food. You can see my dilemma. Fortunately, on Friday there was another resident who had to stay late, so I was able to drive to McDonalds and get dinner there. This will not always be an option. Continuing on the "no-frills" theme, the whole hospital just has this atmosphere that is impossible to describe. Getting logistical things done takes 3-4 unneccessary steps (it took me hours to get my computer access straightened out despite the fact that they gave me a login just over a month ago--and getting meal tickets for call nights [that I may theoretically be able to use some day] was almost impossible). All the employees from clerks to nurses have a "this is the way we do things around here and nothing short of a presidential order no matter how logical or efficient your request will make me deviate from protocol in the slightest" attitude which can really get annoying. That all being said, I'm going to learn a lot this month, which makes it worth it.