New Rotation

It's the first of the month...and that means all across the country, fellows and residents like me are going through the ritual known as "change of service." If you have been at a hospital during change of service, you know what a chaotic time it can be.

I just finished up a great month in the electrophysiology lab at Evanston Hospital. That's where Dr. Wes got me started on blogging. Hopefully I keep the bug, and keep the blog going!

Anyway, change of service is exciting, because you wrap up things you have been doing, and go on to a new experience. The new thing for me is being the fellow in the CCU at Northwestern Memorial Hospital. This is a rigorous job, and demanding of time and mental faculties, but to me it is the best rotation we go through as fellows because we see the sickest patients-- and therefore can make the most difference and learn the most. Change of service can be disorienting to patients, their families, and the doctors. It can even be frustrating. But in the end I think everyone benefits because everyone gets a fresh perspective.

On call

This is a short post because it has been a long day in the cardiac intensive care unit at Northwestern. I am on call tonight -- this isn't the on call of TV where the doctor is in the hospital, running around, saving lives. Been there, done that (except for the saving lives bit -- believe it or not, I feel that happens rarely).

Nope. Now I take call from home, the middleman between the resident and intern who stay, as we say, "in house" all night, and the attending, who stays at home except in the direst of circumstances. I am the one who goes in if I am needed.

I used to be scared of this brand of call, especially because I have to be the one who decides if a person who is having a heart attack has to get an angioplasty in the middle of the night or not. But now I'm not (as much) because I've figured out that 90% of the fear was uncertainty, and 90% of the uncertainty can be removed by "eyeballing" the patient. There is no room for inertia in medicine, I've learned. The old clinical aphorism "if you think you should do something, you probably should" definitely holds true. In medicine as well as life.

They told me that the biggest thing to learn in med school is to learn how to eyeball a patient -- that is at one glance be able to distinguish between those who are very sick and demand immediate attention and those who are less urgently ill. I definitely think this is sound advice. In quest of a person's eyeball sense, or "gestalt", one will often hear docs say, "is this person sick or not sick?"

So if you hear that, please don't think that the doc is silly for asking if a patient in the hospital is sick.

This simple act of eyeballing can change everything. If a picture is worth a thousand words, then a good "eyeball" is worth a million.

So this is for all the docs who are on call (real call, in house) tonight-- keep your eyes peeled, do what you think you have to do, and may you be rewarded with coffee, bagels, and a fast-rounding attending in the morning!