Anonymous Doctor

I just yelled at a med student.

I don't yell at med students. I don't yell. Some people yell. There are a fair number of residents who yell. I've had some of those residents. I'm not saying I'm better or worse, I just don't have it in me. I don't like to be in a work environment where everyone is walking on eggshells. I don't want the people under me to hate me. I don't want to hate the people above me. I want things to be friendly and civil so that spending twelve hours a day here isn't torture. I've had very competent interns and med students who do good work, who make the job a lot easier, who are certainly better than I was at that point, and who I genuinely enjoy being around, despite the work. And I've had interns and med students who work slowly, or make mistakes, and the attending teaches and I teach and we make it work and try to figure out what's causing the problem. And there's no need to yell. Everyone's trying, yelling won't accomplish anything. Even my med student who was making dental appointments in the middle of the day and telling me he had to leave in the middle of a rapid response-- we had a conversation, I tried to explain he needs to take on more responsibility-- I didn't yell.

Until today.

I don't know if this guy is taking lessons from the patient's wife who I wrote about in the last post, or what-- because it's pretty much the same story, only worse because this is a soon-to-be-doctor.

We have a patient who's not eating-- can't eat. It's not useful to explain any details, but it's a malnourished patient who needs to be eating and can't eat, and we're trying to nourish her in other ways but she's rapidly destabilizing. We had to move her to the ICU. We happened to move her right as they were coming around with the dinner trays. We get her out of her room, and my med student turns to me and says:

"I could probably steal her fruit cup, right?"

Then, off my look: "What? Too soon?" he says.

And I grabbed him. Okay, I probably didn't actually grab him, but I made it clear that he should follow me. And I took him into the stairwell, because we don't have private spaces, because we're prisoners, forced to be here for what feels like days at a time.

"This patient might die."

"Oh, I was just trying to make a joke--"

"Yeah. This patient might die. Do you understand that? We just moved this patient to the ICU because this patient might die. This patient, who we are supposed to keep alive, might die. Today. She might die today. And you're making a joke about her fruit cup?"

"I'm sorry. I--"

"I don't care. There is nothing you can say to justify it."

And I left him in the stairwell to deal with himself. Look, I don't know if I'm a hypocrite. There are patients who say stupid things, there are patients who are frustrating to deal with, there are families that are frustrating to deal with, we all cope in different ways. I'm not one to talk, given this blog. We sit in the call room and talk about the patients, we sit in clinic and talk about the patients, stories get around, not everything that is said is appropriate. But hopefully there is a difference, and there's a line. Death is real. You come in and complain about a "new cough" you then say you've had for the past thirty-three years, making a joke about that in the call room is one thing. But you watch us wheel out a patient who's clinging to life and may not survive the day-- and then you want to make a joke about *that*? I hope there's a difference. I think there's a difference.