List of grievances

In the spirit of upcoming Grand Rounds, to be hosted by Doctor Grumpy in the House, I have decided to embrace my less flattering side and share it with the world. Lists are sometimes a nice way of condensing life – or work, or whatever else – into a concrete set of points. This list of grievances will ultimately be followed by a list of gratitude, once I muster up enough positive emotions in the weeks to come. In the life of a medical resident, it is easy to come up with a long list of grievances – I will only focus here on highlights.

1. Call. 30 hours of work in a row, often without any sleep, is exhausting. But weekend call is the worst, because just as I go to lie down for my 20-minute nap of the night, I remember that the cleaning staff  (unlike the resident staff) is off on weekends. The call bed is unmade, dirty, with wrinkled sheets and strands of hair still lingering from the night before. And spending the time to go back to the supply room to get new sheets and make the bed? Well that just took up 10 minutes of my 20-minute nap. Lovely.

2. The 3AM phone call from a nurse, right in the middle of that 20-minute nap, to inform me that a patient wants to leave AMA (against medical advice). In the middle of the night. With IVs in and all. As I contemplate my trek up to the patient’s room, and as I contemplate how on earth I am going to convince him to stay when I myself don’t want to stay, I only have one word, still vivid in my mind from the first season of Grey’s Anatomy. Seriously? I mean, seriously.

3. No windows in the emergency department. I have yet to find an emergency department with windows. If one exists, please let me know. But there must be a reason. In one of the old emergency departments, several years ago, the psychiatric rooms did have windows – close to the ceiling. A patient tried to escape by jumping out the window, broke his arm, and walked back into the emergency department through the front door – now complaining of a broken arm. So maybe windows are not a good idea.

4. Getting paid $10 an hour after over 5 years of post-college education. $10 an hour, with hundreds of thousands of dollars of loans still to be paid. When one of my patients, who left school after 10th grade and now works part-time mowing lawns, found out how much a medical resident makes, he said to me, “Are you crazy? Why on earth are you doing this?” I smiled. No need for an answer – I’m pretty sure that question was rhetorical.

5. My first month in the emergency department. I walk up to a patient to introduce myself as his doctor and to see how he is doing. I am greeted with a string of words which do not need to be mentioned, followed by spit – yes, spit – in my face. A good reason to wear protective eye wear at all times. After number 4 above, isn’t it wonderfully rewarding to care for people who appreciate it?

6.  No lunch. I have yet to eat lunch while working. Whether the shift is twelve hours or fourteen, it makes no difference. At noon you think it’s fine. I can do this, you tell yourself. By 3pm you are tired and famished. By 6pm you are delirious and cannot remember most of the events of the day. Whenever the resident staff increases, people should buy stock in companies that make granola bars and snack packs. On the upside, the less you eat and drink, the fewer bathroom breaks you need to take – those aren’t always feasible either.

7. No snow days. That one is painful. I can no longer turn on the radio to listen to the long list of school and business closings after a huge – and I mean huge – snow storm. Driving conditions are dangerous, they say. Streets are not plowed. Not a time to brave the roads. Everything is closed. But the hospital is open. And the emergency department will need to be caring for all of the people in car accidents who went against better judgment and did brave the roads – most likely the only people crazy enough to be out there are health care workers anyway. This December I will be there yet again, digging my car out from under snow banks to get to the surgical intensive care unit by 5:30AM. All through the holidays. Life is wonderful.

8. The parking garage. On the one hand, this is a perk – I do not know how I would survive residency without the parking garage, which shelters me from the elements and is so loyal in providing me with a parking spot. Not that I don’t pay for this kind of service, mind you. I do. But it is the absolute worst when, delirious after a 30-hour shift, you cannot remember where in this 10-story garage your car was parked. You can spot one of us a million miles away – wandering aimlessly through the rows of cars like lost souls – the post-call residents, tired as death, pale from exhaustion and dehydration, barely able to walk straight (in fact, studies have demonstrated that driving post-call is similar to driving drunk), searching for an escape from this place. Tragic, really. But the security guards monitoring the cameras must have a good laugh as they watch us trudge up and down the stairs, through the rows, pressing car alarms which always seem to run out of battery at the most critical time.

9. Screaming patients. No, I do not mean yelling loudly. I mean screaming at the top of their lungs. There is a difference. And these patients are determined – they open the curtains, open the doors, flail about for attention, and even follow physicians to their seats in the center of the emergency department. Relentless. And then they proceed to scream at the top of their lungs. It inevitably begins with “doctor” or “nurse” followed by a long string of often incomprehensible (and maybe it’s better that way) grievances of their own.

10. And the last grievance – on a more serious note, it is difficult to be an emergency physician because we often go unnoticed. Internal medicine physicians and specialists are able develop relationships with patients and their families over time. Because of this, they can see the effect of their work and can receive gratitude from their patients. Emergency physicians are there at the most critical moment in a patient’s life. Although, if the job is performed well, we do make an impact, it is only fleeting. And we are often not thanked – when people think back on their hospital stay, they probably cannot even remember the emergency physician’s face or name let alone their interaction together. We are the unsung physicians in the hospital. But we play an important role nonetheless.

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11 Responses to List of grievances

  1. Charlene says:

    Thanks to you (all of you emergency docs) my son survived a life-threatening asthma attack and you saved my life after a serious accident. Your kindness, empathy, extraordinary ability to take in so much information and embrace family dynamics is nothing short of awesome- all the while keeping a calm demeaner. The emotions are so high and everything can seem so uncertain and chaotic while in emergency, it would be a nice idea if the patient was given the attending doctor’s name and a phone number so they could actually follow up with a thank you.Once a patient is released from emergency to go home or is put in a room–there seems to be no pathway back to finding out who treated them and how to get a ‘thank you’ to the doctor. Just a suggestion but all in all….just wanted to say thankyou!

  2. Not House says:

    As a medical student interested in Emergency Medicine, I’ve been pouring over your blog the last little while. You offer a lot of insight, and are much more forthcoming and unabashed then a lot of the other people I’ve spoken to.

    Please keep up this excellent blog!

  3. Pingback: Welcome to Grand Rounds, year 7! – more on FunMelaMasti.com | Desi Dramas and Movies

  4. Kara says:

    There is windows in the emergency department of the children’s hospital I am presently sentenced for residency. The emergency room in the nearby adult hospital is a cave however.

  5. John M says:

    I have some solutions for you:
    1) At least there are clean paper towels and toilet paper in the doctors’ lounge bathroom (aren’t there?).

    2) Before waking the doctor, the nurses should remind patients that they won’t get that tasty hot breakfast if they leave during the night

    3) Mount a web cam outside and displaying the image in the ER so the doctors know if it is light or dark out

    4) Yes, but what about all the fringe benefits like those free white coats?

    5) See #3 – This time put the web cams in the examining rooms so you don’t actually have to walk in and be a target

    6) There are enough delirious patients (see #5), we don’t need delirious doctors too. Have a large pizza delivered to the ER in the middle of your shift. Better make that 5 pizzas so you get at least one slice.

    7) Admit yourself to the hospital with a complaint of utter exhaustion the night before a major snow storm. At least you know you will get clean sheets and you won’t have to dig your car out in the morning

    8) Get LoJack installed. Before leaving the hospital, call LoJack and tell them you think someone took your car. They will tell you where it is!

    9) Web cam again – when you are talking to the patient, turn off the volume

    10) Seriously, you are the eye of the storm when fear, pain, and emotion are whirling around the ER. Although you may feel that your presence sometimes goes unnoticed, your absence would have a serious impact.

  6. Med student says:

    Maybe I should quit while I’m not too deep in the red from this loan debt. Any thoughts?

    • Although I have many of my own (inherently biased) thoughts, they cannot answer your questions – you need to come up with the answers during your journey. But a couple points to remember. (1) Know what you’re getting into. Talk to medical students, residents, fellows, and attendings. Get a sense of what their lives are like. Ask them if they like their jobs, and why. Don’t be afraid to ask questions. (2) Remember that residency is not your career. It is a finite training period. It will – whether it seems like it or not – end eventually. The more important thing to look at is the life of a physician after residency. If that’s something you still want to do, then stick with it through the tough parts!

  7. emmy says:

    $10 an hour, seriously? I’m speechless.

  8. Mom! says:

    Well, all I can say, on behalf of the many who’ve passed through those sliding doors, is that you have seen us at our worst…..scared, hurt and sad. We may not have said anything, but look into our eyes. You matter. A lot. So, sorry for these conditions because they aren’t fair, but keep that lovely sense of humor!

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