Hippocrates In San Diego

Oh! And…

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Run

Sadly, after only a week of use, my Nike SportBand fried after a few hours being charged, causing some cracking in the LCD screen. It took a few weeks to send it in for an exchange, and finally I’ve started running again — short, slow runs, but good nonetheless.

Perhaps, perhaps

I think I’ve finally discovered a way to record my runs and post them here — using the Nike+ website with my new Nike SportBand.

The zeal, bravery, and good behavior of the officers and men on the night of June 30, and during July 1, was commendable in the extreme. — John Buford

I’m just finishing another two-week shift at our smaller boutique hospital in the north of the city, covering the final week of the last academic year and the first week of the current year. This is always a challenging time to be on the wards; fresh med school graduates are starting their internships the last week of June so there is a lot of learning happening. And a lot of stress — the interns are stressed, I’m stressed, and the patients are stressed because one day their doctor changes from a confident, knowledgeable and efficient first-year resident to a scared, sheepish, quasi-medical student who suddenly has a long white coat, two new letters after their name, and the power to make serious decisions. If there’s anything I can pass along to you, dear reader, is the advice that you never, ever, EVER get sick enough to require hospital admission around the first of July. The risk of badness happening is several orders of magnitude greater during this tenuous time.

Of course the interns always, especially during this time of year, have the backup and support of their senior residents and attendings. But there are always those situations where a perfect storm of happenstance comes together. Take for instance an older woman, suffering from dementia and recovering from a recent stroke, and admitted for a urinary tract infection and delirium, who was discharged from my team recently. Normally when someone comes into the hospital, the residents’ first thought is about how to get the patient out of the hospital. This is made easier when the patient comes from a nursing facility; unless the patient or their family are unhappy with the care provided at the facility (which is a common occurrence) chances are the patient will return to the same facility after discharge from the hospital — making discharge planning a snap. This particular woman came from a good facility and was found to have a fairly straightforward, treatable problem. Easy, right? Normally you’d treat the infection, and once the patient had improved sufficiently you’d ship them back to the nursing facility to be cared for there. All of this, however, depends on the careful communication between members of our team, our hospital’s case managers (nurses whose job it is to coordinate discharge services for patients), and the receiving facility. In this particular case there was a lapse in communication — probably because I was inattentive and assumed wrongly that the weekend-covering case manager, a new intern, and an end-of-the-year resident (who was looking forward to 8 weeks of research) would make the appropriate phone calls. So the patient was sent back to the nursing facility, which was not expecting her, and her family was surprised to hear that she had left the hospital. Not cool. Unexpected things happen, and I don’t think there was a willful lapse of duty on anyone’s part; but these things seem to happen in teaching hospitals during the early summer more often than other places or other times of year. The end result: an expensive and unnecessary transportation and readmission through the ED, a reworking of the patient by a different team (since she has to be admitted by the particular team on call that night, which happened to not be my team), and annoyance and frustration for the patient and family.

The lessons of July are many. I think for me, being just a couple years out of my own residency training, the most important lessons are that we all have limitations and we all rely on the others to back us up when mistakes are about to be made. However the world is completely different when you’re an intern compared to life as an attending — I’m the one expected to back up the resident and intern, and that is sometimes a daunting task. These residents, and even these green interns, are smart people, and I constantly find myself challenged to stay ahead of them. I am frequently taught something new by one of the residents, something I failed to learn or something I forgot since residency. It’s the nice (as well as profoundly humbling) thing about teaching — there is always something to learn even when you’re the one who is supposed to know more than everyone else.