flight of the phoenix.

wow. 3+ months since i was last here. time flies, i guess. what happened was that first i got busy--a month of trauma surgery--and then i got lazy. in actuality, the trauma month wasn't that bad. it did involve getting to work very early (6am...ok, not that early) in order to "see" all the trauma patients; then there was a flurry of work with rounds, etc., until about 1030-11am, and then things would generally calm down.

the trauma service can be very busy--it seems that degenerate, sociopathic, alcoholics often do things like fall down stairs, drive their cars into bridge abutments, etc.--so there may be 20-30 patients on the service. rounds are at 715am, and in theory the intern is supposed to have seen all the patients by that time. some quick math would reveal that, at 5 minutes a patient (a conservative estimate since in those 5 minutes you have to, track down flow-sheets, write down vitals, talk to and examine a person, listen to their whining...; not to mention the walking all over the hospital to see people on different floors), this would take 100 minutes. that would require getting to work at 530am, not horrible. did i mention that they also wanted your notes written prior to rounds? adding another 5 minutes per person and i'm arriving at 4am. when the service swells to 30, as it often does in warmer months (apparently warm weather and sunshine is a catalyst for idiotic behavior), one would have to arrive at 3am!

but then there is the 80 hour work week limit, and it's not hard to see that if one arrives at 4am and goes home at 7pm, it's hard to adhere to this. the solution is that the official policy is that one is not to arrive prior to 6am. but it's still expected that all the aforementioned work is complete. if that sounds dubious, you are right, it is. this issue is handled basically in 3 different ways: 1--some people actually arrive at 4am in order to get all the work done and then lie about it. 2--others will arrive at 6am, do as much as they can, although they never are really close to getting it all done, and then freely admit it; attendings cannot be openly angry since that is the official policy.

3--still others (including me) will arrive at 6, collect the necessary data, and see only certain patients (this depends on multiple factors, such as how sick they are, what happened overnight, etc.), and talk to the nurses quickly about any acute events. thus armed, these people can then pre-round on the entire service in the 75 minutes allowed and when it comes time to round with the entire team, it appears that you have pre-rounded on everyone. this leaves the attendings happy, and the intern looks like a hero (ok, maybe not a hero, but at least not like an incompetent slob).

i never outright lied about having physically seen a patient that morning or said i did something that i hadn't; i did dissemble, but there is a difference. the other thing i never did was say that i had arrived earlier than 6am (which i hadn't); and i never complained about hours, the patient load, etc. no one likes that. if you complain you get labeled as such, and it will stick with you for the rest of your resident-years; obviously as an ED resident i will be calling the surgery residents quite often and therefore i want a good working relationship. what you want most of all is to keep everyone happy (including oneself), and make it look like things are not as miserable as they really are. how did i accomplished this? i came to work at 6am and busted my ass for 75 minutes. i did only what was absolutely necessary during that time so that on rounds i was ready with the essentials, and because of this, it appeared that i had done everything. i eventually did all the requisite tasks, but some things do not need to be done at 6am. the attendings were happy, they respected me since i never complained, and the work environment was far more pleasant.

the ED intern who followed me did not heed this advice. he complained about the hours, the amount of work he was expected to do in limited time; he never used my strategy of doing enough in order to give the appearance that you had done it all. the month did not go well for him. i was working in the ED the next month and saw he getting screamed at by a chief resident and an attending on 3 separate occasions. there were meetings with our program director, the trauma surgery chief, in addition to daily battles and complaints about this or that. no everyone from surgery dislikes him, and i suspect there is some discontent in our department as well.

there is a time and a place to complain; this was not it. one always must pick which battles to fight; sometimes, especially as an intern, you have to suck it up and do the things that suck and not complain about it. i freely admit that as an ED resident my hours aren't that bad, particularly compared to those of a surgeon, and especially surgeons who trained prior to the 80 hour limit. complaining in that circumstance is asking for trouble. he got it.