Thursday, January 11, 2007

Evening Rounds

It will come as no news to anyone who reads this blog that there are differences between surgeons and physicians. (Ha, low blow already, obviously I've picked a side) Anyway, that difference was made starkly apparent this evening on rounds.

Rounds, for anyone who doesn't know, is what docs call our going around as a treatment team to call on each patient we are taking care of. On a medicine service, this usually involves going into the patient's room, saying hi, chatting a bit, doing a quick (for medicine) exam and discussing findings and options, usually about fifteen minutes per patient if we are moving lighting (again, for medicine) speed.

Today I witnessed absolutely the quickest patient rounds I've ever seen. We saw the first patient, who is about to be transferred out of the SICU, and the chief resident literally looked in the door, pointed, and said in an earnest and friendly voice: "you okay pal?" Recieving an affirmative answer, we went to the next room.

As a future internist, I was a bit surprised. I mean, the guy is getting better, but he's still in the ICU. But, like I said, there's a difference between our styles of thinking.

A lot of it, I guess, is in the nature of the problems we face. For a surgeon, the patient's big problems are behind them once they get out of the OR. (And heck, if a neurosurgery patient is aware and talking, things are going fantastically well.) For an internist, they are probably only beginning. And while I respect the surgeon's drive and intensity, I possess more of the thoroughness and patience of an internist. Residency choice confirmation #203.

And as a short commentary on yesterday's post, two things. (I love numbered lists. For some reason, I think that fits with the topic at hand...) One, you know you're tired when you put the honey for your tea on the coaster, rather than in the cup. But two, with warm food and a job that is fun, lack of sleep fades in significance.

But I'm still headed to bed.


Steve Hayes said...

Surgery, though sometimes necessary, is very much the mechanic tinkering with the mechanism of the machine - the opposite of holistic.

Though, as you noted in another post, it can lead to nihilism, and the thought that perhaps there really is nothing more. That would make "holistic" an illusion.

But, from an internist point of view?

Let us throw back our heads an laugh at reality
which is an illusion caused by mescaline deficiency.

At sanity
which is an illusion caused by alcohol deficiency

At thought, which is an illusion caused by the electrochemical structure of the human brain, which, had it been otherwise, what is now commonplace would be beyond our wildest imaginings, and what is now beyond our wildest imaginings would be commonplace.

MrStandfast said...

Don't you find it amazing how you rigorous your training has been? I mean, in virtually one breath you could be diagnosing and prescribing treatment, and in the next, failing a field sobriety test.
Think of it this way, you're in one long cerebral hell week, teaching you to perform feats of medicine on instinct, but in no way guaranteeing you honey in your coffee and not adhesive between your coffee and your coaster.
Remember that special we saw on the blackfeet tribe? Where they drag the young men around the town square by fishhooks after they've been encased in mud and hung above a firepit for days....then they become men. Just think, they had no idea what pleuresy was, and certainly didn't have coffee. They had honey though. And probably didn't spill it on their coasters. You decide which is better.

Ryann said...

I'd be more concerned if you put the honey on the coaster and didn't notice until weeks later, when you couldn't pry the mug off.

Kate said...

last week I put my milk back in the cupboard instead of the fridge when I got home from a night ER shift I was observing at. Oops!

Nathan said...

steve - that is true. I want to have a deeper response to my thoughts on the matter. In the end though, it usually boils down to Walt Whitman, "when I heard the learn'd astronomer." I think I'll post the whole poem here in a bit, because it's worth reading.

mrstandfast - for someone who doesn't like Faulkner and Joyce, you certain seem to enjoy stream of conciousness writing. And though I can't say for sure, I think some of the neurosurgery residents would rather undergo that coming of age ceremony than their residency.

ryann - do you speak fomr experience?

kate - thanks for dropping by. Unfortunately, you haven't shared your profile, so I'm not able to see if you have a blog yourself. Have you?

Steve Hayes said...

I think I posted a link to a friend's blog on nihilism in response to something you had about neurosurgery in an earlier post.

I long ago realised that for me the choice was between Christianity and nihilism. I haven't solved the conundrum of the ghost in the machine, but whether there is one or not, I believe that God has got us all backed up on tape somewhere.