I was not on top of my game this morning. No excuses, I was just off. Way off.
So, on rounds this morning, I'm trying to relate the stories of each patient to the team. This is kinda funny, since everyone already knows what's going on, but more on that later. I started off with a patient I had just picked up and hadn't read about real thoroughly.
It showed.
I started with "this is a 2 year old male who presented with an acute exacerbation of asthma" and I didn't get any farther. My resident spoke up with "um, no..." and my attending jumped in with "this is unacceptable, you're wrong with the chief complaint."
See, this patient had actually come in because he had a seizure. No asthma, and he wasn't quite 2 either. I was reading the wrong notes.
I managed to piece something relating to him together, but I floundered, bad. "But," I thought to myself, "I have two more patients to redeem myself with."
This is what authorities refer to as "wishful thinking."
Patient number two is up, and I get a little farther. I manage to have the name and age right, and I even have her reason for being in the hospital down. I'm starting to relax, just glancing at the notes, when I say "an attempt was made to start a peripheral IV, but it failed, so she still has a scalp IV." This time the resident comes in with "I think you're a day behind. I placed a peripheral IV yesterday," and my attending, losing his patience with my idiocy, asks "did you even see the patient?"
Truth is, I had. It was just 6am, I'd had four hours of sleep, and I talked with her family for half an hour after my examination. I completely missed the missing scalp IV, and I just read what had been written in yesterday's progress note. This doesn't matter though, because if you can't be trusted to see, or rather note not seeing a tube 8 inches long taped to the side of your patient's head, you can't really be trusted for much.
In hindsight, this is funny.
The third patient actually went ok, I got everything right, but by that time, it was too late. I can only hope my attending and resident don't hold this one against me.
The whole experience has taught me that you shouldn't ever be too sure of yourself. You can always wind up as "one of those people."
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3 comments:
I think you're right. I just felt I had to tack something on the end there and I wasn't thinking too closely about it.
However, I would bet I've become a cautionary story that at least 7 people will be telling for the rest of their medical careers. Heck, I will.
I like smart doctors. But I actually prefer well-rested ones.
We liked Peds - the rounds were way later than we had on most rotations. Medicine wasn't too bad - surgery was the worst, and OB/GYN is shaping up to suck rocks too. Can't wait for Psych - that should be a breeze.
Everyone misses opportunities to shine. The trouble with 3rd year is that you have ridiculously long shifts, after and before which you're supposed to do those stupid writeups and oh yeah study for the shelf tests. Sleep gets shoved aside. Which is ironic, when you consider that it's SCIENTISTS who performed STUDIES on SLEEP DEPRIVATION.
The people you've shown a little ass to have shown theirs when they were in 3rd year, guaranteed. And Doctors DO have bad days - which is why they work in teams. Odds of everyone sucking collectively are lower that way, so the patient usually comes out alive. :)
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