the day i became a cynic
i don't know how you keep your soul in this business. maybe it grows back after residency. or maybe you can afford to buy a new one with your attending-level wages. whatever the case, i have found myself rapidly spiraling down the dark tunnel of bitchy intern.
so determined to stay "nice," i began the year all smiles and acquiescence. i was polite and friendly to everyone, never interrupted, went to see every patient the nurses called me for. when an order didn't get followed, or a mistake was made, i had the patience of Job. no temper tantrums here. and what did all this nice-intern attitude get me?
i firmly believe(d) that you catch more flies with honey than with vinegar--the nicer i was to all the nurses, techs, consultants, med students... the nicer they'd be to me. but i will tell you, that was not the case. instead, my agreeable nature got me about twelve times as much work. i should have realized what a stupid adage that is. i mean, who the heck wants to catch flies, anyway?
the nicer i was to the techs, the more they pushed my patients to the back of the line for x-rays and ultrasounds (one told me, "i knew you wouldn't yell, dr. midwife, so i put dr. meenypant's patient first). the more accommodating i was with the nurses, the more bullsh** pages i got at 4 am. "dr. midwife, this patient never got consented for blood. can you come up and do it?" i once made the EGREGIOUS mistake of discharging two patients for the day gyn team (chief calls me: oh dr. midwife, could you please please please do me this teensy favor...) turns out the patients had incredibly complex hospital stays requiring dozens of phone calls to arrange follow-up care, and yesterday i was unpleasantly surprised to discover that i will have the honor of dictating the charts of these two patients (in whose care i never even participated) simply because my name is all over the discharges. how convenient for my chief. and now i get asked to do it all the time.
last friday i arrived to find hours of work left over from the day gyn and gyn-onc teams (discharges, post-op notes, lab follow-ups) and this even before i got a single page for my "on call." and then, then there was the straw that broke this camel's back. i had to write a post-op note on this patient, but i found no record of the urine output (a very big deal in post-op patients, it gives us an idea of the patient's hemodynamic stability).
me: where can i find this patient's urine output?
RN, not even looking up: i don't do that. ask the PCT (patient care tech).
me: where can i find the PCT?
RN: out there. (waving with her hand as she doesn't even make eye contact).
me, wandering around: are you the PCT?
me: where can i find room 12's urine output?
PCT: i just got here. you'll have to go ask the nurse.
me: the PCT says you got debriefed, and she doesn't have the vitals.
RN: well go ask her again. i don't have them.
me, finally getting really really pissed off: no, i need you to stop checking your email, and find this patient's urine output.
RN, grumpily looking at the vitals sheet: i don't see it here.
me, sarcasm getting the best of me: really. i told you that 5 minutes ago. any idea where i can find it?
RN: if it's not here, it probably didn't get recorded.
extensive discussion with PCT and RN leads to conclusion that if urine output did get recorded, no one knows where it is. currently, the patient is 8 hours post-op, with less than 50 cc of urine in the foley bag, which is NOT GOOD. this is where i lose it.
me, in the hall, to the RN and PCT: it is UNACCEPTABLE to have a post-op patient with no urine output recorded. do you see this order? it says: RECORD URINE OUTPUT. not only is it unacceptable for it to have not been done, it is unacceptable for no one to have noticed that it was not done for EIGHT HOURS. now i have a patient who may or may not be oliguric, complaining of abdominal pain. could be normal post-op pain. could be ureteral obstruction. but there is no way to know, now is there?
i didn't exactly yell, but it's the loudest my voice has been since starting residency. i was pissed, and for once, other people knew about it. but i was amazed at the results it produced. RN and PCT suddenly sprang into action, apologizing and measuring urine and offering to search high and low for lost vitals sheets. it was a sobering moment, because i realized that maybe, just maybe my perfect plan to be so nice that everyone loves and respects me wasn't working. being nice has given people the idea that i can be dumped on and walked all over. over the next few days i was more curt on the phone. still polite, but more cut-to-the-chase "what do you want?" i refused to see a consult before the medicine resident did her own pelvic exam (i don't consult cardiology for my cardiovascular exam, now do i?) i told other residents to do their own discharges and post-op notes. i stopped feeling guilty for not answering pages on my way to the bathroom. it feels good to stand up for myself, even a little bit.
in a way, i'm sad that i have to leave that last shred of idealism behind. until i figure out how to be both firm and nice, i'm going to err on the side of firmness, because i can't keep up with nice intern's workload.
and so it has come down to this.
if anyone out there has any suggestions, any magic formulas for being friendly without getting stepped on, please pass them along. i'd like to resurrect nice glorified midwife, maybe for second year.