Her sodium goes up, her potassium goes down, her calcium goes up, her glucose spikes... this is the first time I've ever had to chase someone's electrolytes. Every test means another lab result gone wild, and another correction to whatever we're doing. It's not entirely our fault-- she's going downhill quickly regardless, at worst we're merely hastening her decline by a couple of days-- but it's hard not to feel like you're killing someone. The attending saw the last set of labs yesterday afternoon and started yelling that she's dehydrated and why didn't any of us realize it. But I asked my resident how much fluid to give her, and I gave her what he said... I can't be expected to know the answer to this on my own, and to know enough to second-guess the resident. But the resident doesn't know all that much more than I do. And the attending is hands-off to the extent that it ends up in our hands to decide what to do. I'm sure the patient's family thinks of all this in a very different way-- "they're doing what they can, look at all the medicine they're giving her, her body must really be failing." But the truth is that a lot of the corrections and course changes are because we're screwing up to begin with and can't figure out how to get her blood chemistry stable.
Today's my last weekday on this first rotation-- I'm off tomorrow and then I work a half-day (hopefully) on Sunday... and then I start somewhere else on Monday. It's definitely different now three weeks in than it was when I started. I'm definitely a more confident, better doctor. I'm definitely seeing how there might be a light at the end of the tunnel, how there might be nights I can have dinner with friends, there might be days that don't feel like the end of the world, there might be a way to survive this. But I'm nowhere near confident enough to trust myself to know what to do. I'm nowhere near confident enough that I'd ever recommend someone turn to me as their doctor. I don't know when that all starts to change-- is it a month? a year? three years? or never? Has every doctor I've ever seen had those doubts, wondered if maybe they were killing me even though they were trying to help, worried they were missing something, worried that someone would discover their secret-- that they really don't know a whole lot about anything, and it's all just guesswork and hoping that the body happens to heal itself. We're charlatans in a lot of ways. We take credit for things we're not responsible for-- infections healing, treatments working-- and try to offload the blame when things don't come out well-- it's not our fault, everyone reacts differently, there were no symptoms, etc. It's how baseball players must feel when they get a hit-- maybe I did something good, but maybe the ball just went where the fielders weren't and I got lucky. We get lucky. Or sometimes we don't.
Can't wait for the weekend.