You really get to know a person when you work overnight with them, just the two of you. A resident who seems perfectly competent during the day, perfectly pleasant, friendly, normal-- in the middle of the night can seem like a monster. An incompetent, crazy, screaming, panicking, dangerous monster.
"Seems like the guy in bed 3 has had a change in mental status. Should I take him to cat scan?"
"NO!! We don't have time to be wheeling a patient to cat scan! What are you thinking???? Do NOT take that man to cat scan!"
"I think maybe we should call the attending and see what he wants to do. I'm worried there's something going on."
"DON'T YOU DARE call the attending! If you call the attending, I look like an incompetent resident who can't control my interns. We don't need the attending. I know exactly what's going on."
"Are you sure?"
"Don't ask me that again."
Next morning, the attending's doing his rounds:
"Seems like there's been a change here. Why didn't you get a cat scan?"
And the resident says, "oh, we wanted to, but there wasn't time."
"You should have."
"I know." She looks at me. "We should have."
The attending looks at me. "You should have."
So do I throw the resident under the bus? Or do I just play along?
I play along. Because I'm a scared little intern, and I don't want to make an enemy. Ugh. The hierarchy here isn't anything near what my friends at banks and law firms tell me it is there, but it's still pretty powerful. You can't question residents, and residents can't question attendings, without feeling like you're putting something on the line. You have to be sure. You have to be positive. And when is an intern positive? Never.
He got his cat scan. Turns out it would have been too late to do anything even if we'd done it the night before. So no harm. But still, next time there might be.