Estoy aprendiendo.

I said good-bye to yet another Attending today. Sad as we are to see another teacher move on, we knew he wasn’t happy at Westchester.

He’s not replaceable, but there have been a couple new hires recently. One in particular, apparently comes with the reputation of being able to turn around hurting programs. Having a discussion with another one of my Attendings, he confessed to me that he as well would have long moved on from us had it not been for this particular Attending coming to Westchester. Said he would give it a year to see what happens. I made him promise to at least give it two. The rate of Attending turn over in the past four years... absolutely ridiculous!

As I continue to learn and start to develop my own preferences and opinions on protocols in place, the more I start to notice and appreciate the lack of common sense in what we do in medicine. We act and make decisions, even develop protocols, entirely based on protecting our selves from litigation rather than what is really necessary.
For example, I tried to give some push back to a request from the ED last night. Immediately got a retort that it’s “how it’s always been done.” I didn’t push any further, interpreting the futileness of such an effort against someone unwilling to think independently. So I acted according to “protocol,” feeling incredibly pointless in the process recognizing that what I was doing was completely unnecessary.
Another case last night was transferred to us from a hospital in upstate New York. Patient was actually flown to us and activated as a trauma on arrival. Patient had trauma to his upper chest and then an incidental finding in his distal abdominal aorta. Looking at the case with a little forensic common sense the force and direction of trauma the patient had to have received in order to result in his thoracic injuries leaving essentially a benign abdomen on exam, would have in no way caused the small incidental finding in the distal abdominal aorta. Understanding the first hospital had reacted out of protocol, we couldn’t fault them. Unfortunately, it had given the patient and his family the impression that he was requiring emergent surgery and about to die without it. As you can imagine, they are both confused and borderline irate when we do not react in accordance with that impression. It was an interesting conversation explaining things and calming them down to say the least. But definitely not the worst I’ve been through. They were calling me Heidi by the end of it, for some reason I reminded them of the Swiss children’s story heroine. Like I said, it was an interesting conversation, but I took Heidi as a good sign and a time to exit finally. My point of that case as well, is the lack of common sense leading to much confusion, misunderstandings, and a 50,000 helicopter bill, all for us to pat him on the head and in reassuring tones say “you’re going to be okay?!”

Much Love.