List of grievances
September 23, 2010 12 Comments
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.