you say pessimism, i say realism; no. 20.

i expect the worst when i go to work. i plan that everyday is going to be long and painful. that patients will be sick and difficult and whiny. i set my sights low for what time i will depart. what i'm saying is, i fully expect that each day of work will be like the 7th circle of hell. well, maybe not the 7th...maybe the 4th or 5th.

anyhow, there is a method to my, err...madness. no, i mean sensibility. my general reasoning is as follows: if you enter into something with the expectation that it will be a horrible disaster, and it turns out to only be half a disaster, then you leave feeling good. the converse is that if you expect warm, happy, pleasant things, and in the end someone coughs bloody phlegm onto your new tie, well, you would be disappointed, to say the least. some more examples: if i think that i am going to go home at 330pm, and i leave at 530, i wind up angry for the rest of the evening because i left 2 hours late. however, if i plan on a 5pm departure and i actually get out at 430pm i am overjoyed because i left "early." i excel at convincing myself of things like this. similarly, on call days, i fully expect to admit 6 new patients (the maximum we can admit on any given call day). it's not hard to see why--if i plan on an easy day with 3 new folks and i wind up with 5, i fly into a rage, but if i expect 6 and end the night with 4, i feel blessed.

it is truly amazing to me how quickly i have been able to convince myself that my life isn't so bad by merely keeping my expectations low. i also frequently adopt the "it could always be worse" position.

does this sound a bit morose? well, it shouldn't. consider the alternative: i expect great things every day--that patients will be compliant and truthful, that i will not get a surfeit of inane pages from nurses at 3am, just as i have fallen asleep (eg, on my last call night i got called at 445am by a nurse who just wanted to know if it was acceptable for the patient who had requested a stool softener at 11pm who was now sleeping to get in the morning and or if she should wake him up and give it. you be the judge. strange that i got called about this but not the man with pyelonephritis (infection of the kidney) who had a blood pressure of 74-48--i discovered this when checking vitals on my patients the next morning), that i will go home at a reasonable hour (yes, i know i have brought that up many times, but i work 80 hours most weeks, so forgive me if i want a little extra free time), or that each day will not be worse than or equal to the day that preceded it. if i behaved that way i would quickly become the facinorous man i was last year as a surgical intern. that would not be beneficial to anyone.

so i will continue on this way, willfully ignorant of the way things are, but smiling each morning when i get to work. well, perhaps not smiling, but perhaps not scowling, which is more than i can say for some other residents i know.