I’m not comfortable with the fact that this was, somehow, allowed.
And blood transfusions are really the WORST example, because there’s so many safety checks between the blood bank and the nurses – but even so, the fact remains: I have waaay too much responsibility.
And it’s not the “so many things I have to do!” kind of responsibility – it’s the “so many things for which I am legally and morally culpable!” kind of responsibility. And I am not used to that.
Med school does not prepare you for that.
Today I carried the other intern’s patients, because she had continuity clinic. And I got a page about a patient with, say, pancreatitis. “Still in pain after I gave tylenol dose. Can you put in an order for motrin?”
… Can I?
Sure, I checked up on the patient first. But even after that, it took me at least 5 minutes of research to feel confident that motrin was definitely okay in pancreatitis. (Why wouldn’t it be? Shit, I don’t know. Stomach ulcers? I just had a general feeling of unease about it).
Then it took me 10 more minutes to figure out how to prescribe it, because of finicky things with dosing and formulations. And then I was unsure if I maybe overprescribed it, so I had to call the pharmacy to double-check.
The nurse was not amused by the delay.
So yes, you could say intern year is going great.
I got another page today: “Patient ‘TotallyStable McHomeSoon’ is desatting to high 80s on blow-by, sBPs in 80s. Please come to bedside to assess.”
So I jogged over, assessed, gave a few obvious orders (Nasal canula, 1 L. …. Nasal canula, 2L… albuterol on stand-by…), came up with a reasonable assessment and plan, and left the nurse at the bedside so I could quickly update my senior resident.
I figured she’d probably be okay with my management, but might be deservedly annoyed I didn’t inform her sooner. I mean, this kid was initially unstable.
But she just said “Right, I heard about that patient’s desats,” – and with great restraint and calculated patience, she continued: “They told me first. So I told the nurse to page you.”
Which… what? Excuse me?
WHY WOULD YOU DO THAT.
So I went back in the room, kept managing him – and the patient turned out fine (eventually stable on room air) – but I do not like that kind of pressure.
Even worse, one of the things on my differential was that I had recently reconciled all of his many, many medications – and some weren’t on formulary, so I had to call the pharmacist – and… maybe I made a mistake? Maybe this was pharmacologic respiratory depression? He had just gotten his morning medications, after all.
So for at least 5 minutes, I was seriously considering the fact that I might have made an inadvertent error that could have seriously hurt someone.
I didn’t. Turns out it was something else entirely – but… the bright feeling of “Whew, I didn’t make a mistake!” is being tempered by this inner voice that’s adding “This time” to the end of that sentence.
Why would anyone WANT this kind of pressure? Who the hell decides to be a doctor? Who wants to reconcile outside medications, knowing that there’s a chance you’ll make a minor error, and see a patient in acute respiratory distress?
(Again: I was not the cause. I reconciled perfectly.)
(… this time.)
We had a code today, too. I was ecstatic that – despite being disturbingly close by when the code was called / the alarms went off – I still somehow managed to be too late to be of any use. (YES! The holy grail: responding emergently like a responsible person, and not being needed.)
Still, I stuck around with about 10 other residents / attendings / nurses in case they had to go to chest compressions and needed the extra help.
Chest compressions, I can do.
This day-to-day “ordering potentially life-threatening medications under my god-given name” thing? That’s much harder.