So, if you've watched any doctor show on prime time you know that supply closets can be a very busy place. It's a place for residents and attendings to hook up, for med students to hook up, for nurses and docs to hook up, for patients to hook up . . . well, according to most of those shows that's all anyone does in those call rooms. In a real life hospital a supply room is used for one of two things, stocking supplies and a safe place where a resident can go to cry.
On Thursday night I had my first experience with an attending chewing me up and spitting me out. When I came on the Burn floor that night my chief told me how very critical a new admit was. That because of his burns we would need to resuscitate him drastically but that because of his preexisting congestive heart failure if we did so too much we could literally drown him. And so I was to follow his hourly urine outputs and report back to him with any changes. In addition to managing the other 80 patients I was covering for that night and admitting any new burn patients. But that's what I'd signed up for so that is exactly what I did. When our patient's urine output suddenly spiked around 10 o'clock I was thrilled and called my Chief who said to go ahead and lower the rate of of fluids from 1,000 mL/hr to 750 mL/hr. It was quite a drastic jump but I didn't know that at the time and I asked the nurse to make the changes right away.
A few minutes later the charge nurse (the head of the nurse for that unit) received a phone call from the attending who had been following that patient. I decided to stick around in case he decided to make any changes to the patient's care. But I noticed that the charge nurse was getting increasingly more agitated and eventually handed the phone over to me. I didn't know what was wrong but I was about to find out.
"Young lady, how many burn resuscitations have you managed?" a deceptively calm voice practically whispered across the phone line. His voice was so soft I had to press the phone to my ear to the point that it hurt. It wasn't until I hung up the phone did I realize that my hand had cramped from clutching the reciever so hard.
"None" I responded.
"So I take it you've never managed a patient with congestive heart failure either. Am I right?" His voice had a dangerous edge even if I'd managed 7,000 I knew there was only one answer he wanted.
"No, sir"
"Well," his voice boomed now, so loudly compared to his previous whisper that I jumped in my seat. "It's a good thing you didn't kill this poor man, then." I was so shocked by this statement that I just sat there in stunned silence. The receiver again pressed painfully against my ear. "As an intern I never would have presumed to make fluid changes on any patient without the express okay of my attendings. I've never even met you. For all I know you could be the night custodian. And with your decision making skills I wouldn't be surprised if that's where you dod go to school." He wrapped up shortly after that. He did mention that I should keep the patient's fluids running at 750 mL/hr and that I should learn to communicate better if I wanted to stay on in this program.
When I hung up the phone I was hard pressed to hold back my tears. I remembered that I had a corpack (a type of naso-gastric feeding tube with a weighted head) to place in a patient who had pulled hers out earlier that evening. I tried to maintain some sort of dignity as I headed into the supply room and shut the door behind me. I leaned against the door and sank to the floor. It wasn't comfortable and neither was trying to control the sobs and the self-doubt washing over me. Had I really almost killed that patient? What had I done wrong? When was I supposed to have called the attending? Was I truly that incompetent?
It took me a minute or two to get control of myself. Luckily they keep tissue boxes in this supply closet so I at least had something to blow my nose on. I gathered up the supplies I needed and went to drop the tube on the patient in bed 8. I spent the entire procedure nagged by my own self recriminations. I went through the next hour or so like that. Second guessing my every move and questioning my own competency. Until I got a call from my chief. I was expecting another lecture. Another close examination of all my faults as an intern and a human being. Instead all my chief said was, "I just got off the phone with attending, he's pissed at you, but he can't remember your name."
I didn't know what to say that. But it was okay because my chief continued "so, what happened there was unfortunate, the attending called the floor before I got a chance to call him."
"But, I still shouldn't have the changed fluids." I said, I'd had guilt instilled in me at a early age and the berating I'd just gotten from the attending proved that it could still take charge of my psyche.
"Actually, you did what I told you to do, and I told you to do the right thing. That's why he didn't ask you to change the rate again." My chief's tone was rather brusque as he said all this. I knew he'd probably gotten torn a new one too and that it was late and he wanted to get back to sleep. But, I was touched that he was taking the time to explain that it wasn't my fault.
I spent the rest of the night pondering that hour. I came to certain conclusions. First of all, this would not be the last time something like this happens. It probably wouldn't be the last time I sought solace in a supply closet. But it would be the last time I would let myself doubt my abilities. I was not performing my best when I placed that corpack. I was pre-occupied and nervous because of the scolding I'd just gotten. And that was the biggest mistake I'd made all night. There are going to be times in the next five years when I'm going to eat shit whether I deserve it or not. But, I CAN NOT let that effect how I care for my patients. There are going to be other residents, chiefs, attendings, nurses and even patients who don't like the decision I've made or the way I've done something. And yes, I need to take the time to reflect on their accusations and figure out where I went wrong if I did go wrong. But, once I've sorted that out I need to regain my composure and go back to caring for my patients with confidence and compassion. If that means a few more moment huddled on the floor of the supply closet then so be it.
Later, after I'd gone home that morning and gotten some sleep I was reminded of an episode of ER I'd watched a long, long time ago. It was from the first season and said by an attending surgeon to a lowly ER resident. "When I was a resident, I was always worried about getting people's approval, the attendings', the patients', maybe because I was a woman, a black woman. Life was a lot easier once I got over it"
I see what she's seeing. I can't do this job expecting everyone's approval. I won't get it and in looking for it I could very well do harm to my patients. So, it looks like I'm just going to have to get over it.
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