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The daily life of a medical resident..
a.k.a "It's 2 AM and I'm looking at urine outputs."
White? Or was is Jackson? No - it started with an S. 
Fri, Sep. 9th 2011
Less than 72 hours ago, I cared for a critically ill patient. The details below are altered to avoid identifying information.

I admitted them to the intensive care unit, did invasive procedures on them, called consultants to assist in their care, and resuscitated them through a cardiac arrest.

I know their lactate was 104 on an initial ABG, their creatinine was 2.2, and they had been on the new alternative to Vancomycin for their resistant infection. I know that they were a code blue response in room 422 at 6:40 PM, received two rounds of epi and were shocked out of pulseless ventricular tachycardia after being intubated by the on-call surgical resident.

I know they were on Dr. _____'s service since Aug 12th.

I recall pronouncing them dead at 0105 with family at the bedside.

I did not know their name.

How is it that I could have been so intimately involved in their care, up to and including giving my condolences to their son and daughter who came to witness their last minutes alive on this earth and not remember something as personal as their given name?

When asked to follow up with a death summary by my attending, I stopped short. I could rattle off their history, start to finish with a full assessment of the likely causes of their arrest and subsequent decompensation as well as the entirety of our diagnostic and supportive efforts, but I found it impossible to recall what name to dictate the summary under.

My efforts to determine my patient's identity were further complicated; my intern, the daytime medicine resident who initially went to the code, the unit coordinator and the head nurse in the unit - not a single person could remember their name. We all remembered the room number, incidentally.

Ultimately, I resorted to pulling up all the echocardiograms done by the cardiologist we consulted for the day of their evaluation. I recognized the findings (LV hypertrophy with preserved EF and no apparent RV dysfunction or elevated RVSP indicating hemodynamically significant pulmonary embolus) and subsequently found the patient's name.

It is a sad commentary when an ejection fraction means more than a name.
Wayne State University Class 2009
Fri, Sep. 9th 2011 (UTC)
Honestly, it doesn't surprise me. Doctors and nurses deal with hundreds of patients a year, expecting to remember the name of every one, even the ones who die under your care would be too much. And in general while you are treating a person, you are dealing with the Problems, and the diseases, not the person. You HAVE to know how to Deal with OMG PRoblem X! its not OMG! MRS WILSON!
Fri, Sep. 9th 2011 (UTC)
We've all been there. It's been my goal on my last few shifts on call to refer to patients as Ms. Blah Blah, rather than the laboring patient in 18. But it's hard! There is so much else to remember, and sometimes the names go by the wayside. But it's certainly worth trying!

I have an LJ post from two years ago which is very similar. I did chest compressions on a patient, pronounced them dead, and wrote the death note, but never learned the name. It wasn't our patient. It was a code that I'd run to, and the resident pulled me in to help and learn. But I never knew the name, and never knew the story, and that really freaked me out.
Fri, Sep. 9th 2011 (UTC)
And the fact that it bothers you, is why you are such a great doctor.
Sat, Sep. 10th 2011 (UTC)
Wed, Sep. 14th 2011 (UTC)
It's a sad commentary -- but not on you.

We need more manpower. We need more financial support. We need a health care system which gives docs like us on the front lines the actual resources we need to help the majority of our patients, who aren't part of the wealthy elite. But our health care system and our country has decided it has other priorities, like ever-bigger tax breaks for the wealthy and maximizing profits for insurance companies. So you do the best you can, with more and more desperate patients, and fewer and fewer resources. They give you more and more patients to cover in less and less time, patients who are sicker and sicker because they can't get the basic health care they need, less and less money to do it with, and leave you to figure out how.

In an ideal world, you'd be *given* the manpower, the resources, the support you need, so that you'd actually have the time to get to know the patient, not just his problems. In an ideal world, you'd have the resources to be able to spend the time to both take care of the body and the spirit. But they didn't and you don't. So you do what you can. Do what you have to. You triage. In an ideal world, a physician is both compassionate *and* competent -- but if you can only choose one; if they only give you the time to be one: we all know which we have to be.

It's not your fault your Tea Party neighbors cheer as their politicians slash taxes on the wealthy and bar regulations on for-profit insurance companies -- and then, when they themselves get screwed by CEOs and budget cuts and insurance company accountants, they show up with their sick parents or children or spouses at your door, and expect you to take care of them anyway. It's not your fault your Tea Party neighbors think for-profit, devil-take-the-hindmost is perfectly fine -- up until it's *them* on the short end of the stick, at which point they demand your time and aid, regardless of their ability to pay. It's not your fault that almost no self-professing libertarian -- not even Ayn Rand herself -- is ultimately willing to suffer the inevitable consequences of a truly free-market health care system, without demanding your time. They set you up to fail. They set you up to be forced to triage. So do your best.

From your mother's own experiences, you knew far better than most that we would end up where we are now. You knew far better than most the impossible squaring of the circle that would be demanded of you as a physician. Of the increasingly impossible task they would ask of you. Yet you chose to come and pay the price anyway. And the fact that you still strive to be the kind of doctor everyone -- even the Tea Party supporters -- expect you to be, despite increasingly strained resources of money and time to do it in -- is a testament to who you are.

I've always been humbled and honored to be your friend, Kat. And humbled and honored to share this profession with you.

Strength, Kat.
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