I’m S-L-O-W-L-Y getting the hospital figured out and am a long way off. We do good medicine to be sure, and it could be so much better but for (fill in the blank). Today our team “admitted” to the ICU a transfer from the local private hospital that had bleeding on the brain and blood that won’t coagulate because of an attempted suicide with rat poison. As I’m in way over my head with this I asked my colleague if he wouldn’t mind helping. In the spirit of the place he volunteered to assume care of the intubated/ventilated patient as I look over his shoulder and catch up on treatment options.
Another consult was for a 14y/o girl who had an undetected pregnancy, on top of cyanotic heart disease, delivered at term, at home, yesterday and came in with renal failure and a pressure of 110 diastolic.
The ICU, much like many of the other specialty areas is a little fiefdom, run by an anaesthesiologist who insists on having the medicine team round but not comment on the very reason the patient is there; the need for support of respirations and circulation. Ohhhhkaay, so we sort of stand around and try to divine what we are supposed to do and not piss this guy off as he has the ability to make our lives complicated and knows it.
Some departments are also the quintessence of political gamesmanship. I’m sure the Divine is testing me in that I truly need more patience for my patients. One department head is the Queen of Passive Aggression. In point of fact, any resource that is in high demand and has limited capacity usually has as its head a political animal, with the exception of Hematology where a delightful German doc simply says to send the patient down whereupon he will see them immediately! So we routinely weigh the need for lab, x-ray, etc. and find ourselves either doing without or playing “the game”. I of course am happy to do this and very understanding (my kids are seizing with laughter at this point).
So I’m in the hospital for the next three months, sure that I’m in the right place, doing the right thing. Would love to hear from some of you. How is CGFM? How’s the new hospital coming? How is fall? Here of course it is the threshold of summer.
Best to you all…
Mike
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3 comments:
Ok, Papa, I know you aren't going to want to hear this, and if you listen, it still probably won't be fun to do but... I think you should make friends with those difficult people!! It is amazing what a "political" person will do for a "friend," probably because they have very few of them. I bet if you go out of your way for a couple weeks to compliment them on whatever you can come up with and say with a straight face, and throw in a couple well timed questions about their kids, dogs, hobbies, etc., you will make life much smoother for yourself and your patients. Don't think of it as kissing up, think of it as your abundant charm put to good use!
Hang in there and keep kicking suffering's butt!
=) Shan
You should try out the tried and true 'happy sandwich'. It's a compliment, what you want to get across, and then another compliment. For example: You're pretty, you're fat, you're pretty :).
In reality though, it has gotten me through some tough times. Just bring in some of Mama's cookies and you're sure to get whatever you want!
Love you SO much,
B
I have found in life (and healthcare) there are two paths-ramming repeatedly into a wall until your sore and the wall bends, but never breaks or find the key to open the door, which will remain open forever. I'm a friend of B's and heard your talk as you passed thru Colorado on your way to Florida and beyond. You are doing amazing work and from your talk and blog you love it. It's unfortunate you have to be a politician and physician, but your patients will be better off for your split personality disorder! Good luck! --phil
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