* * Anonymous Doc

Tuesday, September 14, 2010

Six admits, including a guy I argued for twenty minutes needed to get admitted to the ICU. Arrived in terrible shape, couldn't really be stabilized, we should not be admitting him onto the regular floors, we just shouldn't, he needs more care than that.

No, no, the night attending insists. He'll be fine, they'll deal with him in the morning. The ICU can't handle another bed, whatever.

So we admit him to the floor, I send him up there and then he's not my responsibility anymore. The night attending goes home at midnight. I do five more admissions and try not to fall asleep.

The day team shows up. And I get paged. And screamed at.

"How could you admit him to the floor? We came to visit him on rounds and ... wait for it ... HE'S IN A COMA"

"I didn't want to admit him to the floor, I wanted--"

"Yeah, well, this is your fault."

"How is it my fault?"

"You should have insisted."

"I did."

"Not enough."

So now we have a guy in a coma and apparently I did something wrong yet I still have no idea how I could have done anything differently when there's an attending telling me that I have to admit him to the floor and the ICU won't take him.

And they kept me there for an extra hour to get blood gases and do a whole battery of scut work on this guy, pretty much undisguised punishment as if I deserved to be punished and shouldn't be allowed to go home and go to sleep.

The guy should have gone to a different hospital, and I should have gone to business school.


  1. I guess 20 minutes wasn't long enough....?

  2. Reading through your blogs...interesting stuff but I can't help to think where on earth do you find the time to write all this?? I would think when you leave work you would want to leave it all behind.

  3. Next time: "The attending specifically instructed me to admit him as-is, I insisted, fervently, and did not have the authority to countermand him despite my own medical opinions. You need to talk to him about this. Further, I dislike being put in a position where the health of my patient can be callously overruled, where I am held culpable, and have no recourse. You just saw what the result is. Can we work on this?"

    Grow great big lightning-producin' balls. If you know better, stand up for it, go over heads, wake people up. When you're proven right, as you will be - you ain't stupid - you'll have credibility, advance, develop courage without stupidity, and maybe more people will go home while presumably you do what you love.

    Right is right, buddy - no matter how many committees form or how much politicking is involved. When you're damn sure you're correct, you'd better fight for it.