July 16, 2010
-
Resident Epiphany
I had an epiphany today. A moment where I realized just how far I have come in the last year.
The day was full of little moments like that. I stayed one step ahead of the attending on my patients-I had ordered chest x rays and abg’s on my ventilator patients, getting them ready to be extubated or monitored and the like. I spoke with the radiologists to secure a test for a patient that we had been told previously our hospital didnt do, and I found the secret way to do it. I convinced yet another family to make their loved one DNR/CMO and allow them to pass with dignity (I am getting far too good at that one unfortunately)
But the one that struck home is when, working on my notes in a quiet room, I heard a sniffle behind me and turned to catch one of the interns crying. Two weeks into residency, one of her patients was deteriorating, on a fast road to nowhere, and neither she nor anyone else on the team could figure out why. The family was aware of the poor prognosis, but the patient was still full code, meaning everything would be done if she were to stop breathing, things like cpr, defibrillation, intubation and a number of other things that may temporarily prolong the patients life, but not preserve its quality.
The Intern had to go and discuss code status with the family given the impending prognosis of the patient. Two weeks into being a doctor, this poor girl was faced with trying to convince a family to avoid invasive procedures, to let their family member go if something should happen, to convince one group of people to allow a loved one to die naturally…nor could she even offer them a reasonable explanation as to why the patient was dying.
I could understand why she was overwhelmed. It was less than a year ago that I had been in her shoes (hell, two weeks ago I still WAS an intern) and had no clue how to even pronounce a patient, much less convince a family to change a code status. I sat down with her, and reminded her that it was okay for us not to know what is going on with a patient, that often despite our best efforts people die, that as scary as it is for us, the family is often more scared and looking to the white coat as a symbol of authority for help and guidance. I told her to use the shield the coat provides, to give her recommendations with confidence whether or not she felt it, and above all, to SIT DOWN while having this discussion.
She thanked me, and I went back finishing up my notes for the day. On the drive home I realized, I had finally become a resident. It wasnt about my breadth or depth of medical knowledge. It wasnt about having endless compassion or brisk efficiency. It’s about knowing the right thing to say at the right time where it will do the most good, whether it is for your patients or your peers.
Well played, Life, Well played.
-Dr J
Related Posts:
Post a Comment
Leave a Reply
Why Not Zoidberg
Comments (4)
THIS is why I love ur blogs, cuz this is the side of medicine that people never see. It’s been very interesting to follow your experiences during ur residency. Keep up the good work, Doc! -*M*
Sounds like you have arrived!
Amazing experience. I can only hope to remember these words if I ever have to run through this experience as the intern or the resident.
You rock, Dr. J. You really do.