IM: The things we don't want to be

As usual, we rounded on patients before 9:00 a.m., and on the 6th floor I ran into Chris and we went to see our 29-year-old CHF patient together. He's in pretty bad shape; has an ejection fraction of 15-20% and nothing in his history except HTN and a recent viral illness that could point to a cause of his CHF. Chris showed me how to read his EKG, which showed right atrial enlargement (look for P waves that look like a "sine" wave) "See, you're learning something," said Chris, and I'd glad; cardio was never one of my strong points and I can't read abnormal EKGs to save my life. Andrew stopped by to say hello; he wondered why we arrived at 7:00 a.m. each morning while the rest of them arrive at 6:00 to round. It really depends on the attending; Dr. M likes to round at 9:00 while others round at 8:00.

One of the last patients we saw today was a man with metastatic liver cancer who came to the ER with chest pain, SOB, and a UTI. He was a "bounceback" who had originally been sent to hospice, yet somehow ended up back here. He was on a morphine drip when we went to see him, and we learned that he "shot up" on heroin 2 days ago. Dr. M proceeded to check the patient's back to check for costovertebral tenderness, except he didn't tap, he pounded. The strength he used to hit the patient's back was audibly harder than the strength we'd use for tapotement, and the patient almost screamed from the pain. "Stop...stop!" he gasped, and quickly explained that he had a spinal cord injury. "Oh, sorry," Dr. M said shortly, and left it at that. Annie looked as horrified as I felt, and I thought, That's it? You hit someone's back and cause them excruciating pain, then say, "Oh, sorry" and leave? That patient's back pain was probably secondary to liver mets and why he went out to "shoot up" on morphine in the first place! That was bad. Annie was furious by the way our patient was treated, and I didn't blame her. I mean, I know our residents told us that Dr. M has lousy bedside manner, but this was ridiculous. I know which program in Chicago he trained at, and I don't know what kind of training they have there, but I know one thing: I want to go to a residency program that'll teach me to be compassionate to my patients, not brush them off like dirt, even if they are druggies. I do not want to be like Dr. M, ever.

After lunch conference I asked Sherif what time we should see our patients by tomorrow. He said, "I'd like you to get done earlier, by 7:30, so you can go to lecture with the interns and learn how to read EKGs." I asked Annie if she was planning to go, and she said no. But after working for one call day with Sherif, I know that if he tells me to do something, I'd better do it. So...looks like I'll be rounding on my patients earlier tomorrow so I can go to lecture.