Excuse me while I rant for a few moments.
You ever try to work from home, and not tell anyone? Answer your e-mails, call the people you need to call, and no one needs to know you weren't actually in the office?
Now imagine you're a doctor.
Hey, doesn't really work, does it?
Friday night I thought I had the laziest resident in the hospital. I had to transfer a patient to the ICU-- usually this wouldn't be the kind of the thing the intern does by himself. I'd page the resident, he'd come and take a look at the patient, maybe he'd talk to the ICU resident, maybe he'd call the attending, maybe he'd take a look at the notes that the day team had written, maybe he'd just want to make sure I'm doing all the right things and not going to kill the guy.
So as soon as the patient starts going downhill, I page the resident. Calls back a couple of minutes later. "Oh, sounds like you have things under control. Why don't you handle this yourself?" Okay, whatever, he doesn't want to make sure I'm not incompetent, he trusts me, I'll do what I think we have to do. Patient continues to become less stable. I page the resident again. "Yeah, just keep doing what you're doing, sounds like it'll be fine." While this is going on, I get a page from one of the nurses about another patient who needs to be looked at. I call her back. "Can't right now, dealing with an ICU transfer, page my resident." Okay, back to this guy. I get him to the ICU, we get him stabilized, the ICU intern has everything under control, I start to head back to the floor, I get another page from the nurse. "You really need to get back here and deal with this patient." "I'm on my way-- what did my resident say?" "He said it sounded like it could wait until you were finished with the ICU transfer--"
So I run back to the floor, and, sure enough, we need to call a rapid response on this guy-- the ICU resident comes over, we get this guy stabilized... I page my resident. "Oh, it seemed like you could handle it."
I get home yesterday morning, having gotten no sleep overnight, and thinking this I just had the worst night float experience ever, and had the laziest resident in the world, who didn't even feel like he needed to come help me, and what could he have possibly been doing that was more important than making sure the patients didn't die...
And last night, I find out from the ICU resident-- this idiot's friend-- that my resident wasn't even there. And no one knew, and everyone just assumed he was lazy-- but they realized in the morning when the person he was supposed to sign out to couldn't find him, and he tried to do the sign out over the phone but the day team was insisting on seeing him in person-- especially because of everything that had happened overnight.
And it would be bad enough if he was at home, lying to everyone all night, answering his pages, pretending he was there, it would be bad enough if his "game plan" had been to take it easy unless there was a real emergency and then rush in-- but in fact he wasn't even in the state.
He'd been off on Thursday, and he was off on Saturday-- so he figured, hey, I'm going to go away for three days and I'll just stay up all night on Friday and pretend I'm a lazy resident, answer all my pages, and no one will even know. He was visiting his girlfriend, a two-hour plane ride away.
I am flabbergasted that someone would do this. Not only to the patients, but to his colleagues. I'm a first-year resident, and, unbeknownst to me, I was the only one on the floor the whole night. There was no one else there, two patients need me at the same time, and one of them wasn't going to have a doctor. And if I'd made a bad call-- a call I'm expected I might make merely because I'm an intern and interns make mistakes and that's why we're supervised by residents-- there was no one to back me up, there was no one to step in and fix things. Patients could have died, and it would have been my fault. And I didn't even know that I was alone there.
Needless to say, I'm furious. I'm furious that someone would do this, and I'm even more furious that it seems like the hospital is going to give him a slap on the wrist and nothing more. Because nothing bad happened-- because I did my job-- he gets a, "don't do this again," and "that was really irresponsible," and he gets to keep his job. They fire interns for being slow, and this guy, who skipped a shift, spent the whole night lying about it, and put our 55 overnight patients at risk-- he gets a free pass because he's a third-year, and two weeks away from leaving for a prestigious fellowship.
Like he's going to be a specialist I'd ever send a patient to.
It's one thing to make a mistake, accidentally, while trying your best. Mistakes happen, bad outcomes happen, it's unavoidable. It's quite another thing to try and beat the system, to spend the whole night lying to people, and to knowingly put patients at risk. Be skeptical, it teaches me. Being a doctor doesn't mean good motives.
One more night and then I get to become a normal person again.