Residents are good at complaining about their lives, and I’m really good at complaining.  However, that does not make me a good resident.

Last night, I was on call at one of our “outside hospitals,” meaning a community hospital.  “Outside hospitals” have a less-than-perfect reputation among housestaff, but don’t get me wrong, there are fabulous “outside hospitals,” as I am living proof that you can be born at Outside Hospital and live to tell the story.

Every resident has “a system,” by which they keep track of the patients and action items that they need to follow through on while they are on call, and 99.9% of the time, this system is kept on “the signout.”  Sign-out is when one resident passes on information to the next resident on call about what they will need to know about patients and patient care when the former resident goes off-duty and the latter resident starts call.  It usually consists of a verbal report of patients and agenda items that need to be taken care of, and a piece of paper on which all of this is outlined that is usually typed in miniscule font with various check-boxes scattered throughout.  Residents have their own systems on the paper sign-out: some like to order their events chronologically, writing down everything that needs to happen at every-hour-by-the-hour on their list of stuff to do.  Some like to just put check-boxes next to each item that needs to be addressed.  Some just like to use multi-colored pens to organize their thinking about what’s important (RED for important stuff to do now, BLUE for “just watch and follow,” GREEN for lab data, BLACK for everything else.)  Some incorporate all three techniques.  I am a check-box kind of resident, as are 95% of residents, and on busy services at busy hospitals, I will use the multi-colored pen system as well.  And always, on what I anticipate to be busy nights or potentially terrible nights, I will make myself an agenda item and put a check-box next to it: [ ] Am I having a good time? And it is usually written in blue.

Last night, I went wild, and decided to change my personal agenda item to: [ ] Be an awesome doctor!

That was my first mistake on call last night.  Because being an awesome doctor doesn’t necessarily mean being an awesome resident.  If you imagine a Venn diagram, the two spheres overlap to varying degrees, depending on what stage of training you are in and what your responsibilities are.  And at Outside Hospital, where any interesting, chaotic issue can present itself, the two spheres might not even be overlapping, as was the case last night.

Last night, I spent the majority of my time trying to help this poor patient and these poor nurses who were dealing with her, as she was having pseudoseizures.  After a little while, we were able to get the patient off the floor and into a room and eventually get a set of vital signs but this whole process took about an hour because (1) I couldn’t get into the unit because the unit does not have a working doorbell, and it is locked, and no one knew I was banging on the door outside trying to get in, (2) there were no gurneys or wheelchairs available to get the patient to a more ideal spot other than the floor, so we had to use an office desk chair with wheels to slide her into a room, and (3) the only reason we needed a room is because the room had equipment like oxygen, a thermometer, a blood pressure cuff, and there was no way to get any of this stuff to the middle of the hallway where she was pseudo-seizing, and (4) I guess I was called to this problem because the girl was kind of big, and the two nurses weren’t enough to help her off the floor and they didn’t realize that she was also congenitally deaf, so it was hard to communicate.

Regardless, it felt inordinately bizarre because it wasn’t a situation in which you needed a doctor.  You just needed someone, anyone, anyone at all with common sense, to take charge.  Really, people just needed to be told what to do, because it was confusing, but it wasn’t life threatening, and no one was really sick.  From a medical perspective, she was okay - I just wanted a basic set of vital signs (temperature, heart rate, respiratory rate, blood pressure, oxygenation) to make sure she was okay, and even this was hard because (5) there were no working adult-sized blood pressure cuffs on the floor.  And she was a big girl with big arms.  It was clear this was a patient in a lot of distress, and these were nurses who were at their wit’s end, and this was a psychiatry unit with not a whole lot of technological functionality, but no one was acutely ill, so I felt somewhat at a loss.  Be a good doctor?  How?  Be a good resident?  Okay.  That involves: finding an accurately sized blood pressure cuff to take a good set of vitals on this child; communicate with her by writing things out on a piece of paper and letting her write back; flipping through her chart to find out what her underlying medical and psychiatric issues were; helping the nurses get her to a safe place in the room.

The whole night was like this.  I was dealing with complaining parents, overwhelmed interns, sad patients, confused staff members.  And I realize, there are really very few moments in your life when you need to be a good doctor, in the traditional sense of, oh, saving lives - you just need to be a good resident.  And that only means: make the medical system work in your own small way.