Tuesday, August 21, 2007


I was the only one on my team that showed up today – the MO Boipelo was sick, and Dr. Stefanski is not at Princess Marina Hospital (PMH) on Tuesdays, plus he’s been sick himself. So I had a few problems today. The morning was great! I got all my work done, and it generally went smoothly as I rounded by myself, but I definitely hit a few snags this afternoon.

The main person that ruined my day was this stupid ICU doctor. The first thing he did was yell at me in the morning, as I was standing there doing nothing but writing my note in the chart for my one ICU patient. He was yelling at me about all the other ward doctors not coming everyday to round on their patients in the ICU. And went off on a tangent about how the ward doctors d/c (stop) medications inappropriately once their patients get to the ICU. He must have ranted for about 10 minutes and all I could say was that, well, I’m rounding on my patient in the ICU and this the reason we d/c’d the tuberculosis medications. So he was like, ok that’s reasonable, and said he didn’t mean to rant directly at me. But he did.

So my patient in the ICU was supposed to get a CXR (chest x-ray) two days ago when he was transferred, and they dropped the ball and never got one, so I asked for one this morning. Then this afternoon, I looked at it, and I was a little panicked because he had a collapsed lung and a left pneumothorax! That’s air in the thoracic cavity, and can be really really bad if it starts compressing other structures, like the heart. So I run all the way back to the wards to ask an attending about the CXR to make sure I wasn’t totally interpreting it wrong, and she said I was right, and that I should call a surgeon immediately to put in a chest tube and decompress the air in the thoracic cavity. So I did. The surgeon said he’d see the patient in the ICU, and I went there right away. He got there at the same time I did, and the ICU doctor saw us right away, and came in storming. “WHO CALLED SURGERY?” And that started another rant. I told him the patient had a pneumothorax and he said there was no way. I said I was pretty sure, as both Dr. Gluckman and another attending had seen it. He still didn’t believe me and made me show him the x-ray, and then he got really mad. I think showing him wrong set him off – he started accusing me of trying to tell him how to do his job, and doing things the wrong way (apparently I’m supposed to tell him about the problem, and then he would call surgery). He must have yelled for about 10 minutes and went off on me with things like “WHY did you not call me first?”, “YOU AMERICAN DOCTORS THINK YOU CAN WALK IN HERE AND DO WHATEVER YOU WANT?”, “YOU’RE TRYING TO TELL ME I DON’T GET THINGS DONE RIGHT??” and “YOU DON’T THINK I’M CAPABLE?” I couldn’t get a word in edgewise, and finally I said I’m leaving, and he said FINE GO I DON’T NEED YOUR HELP HERE GO! I was super upset and, actually, pretty angry. I didn’t realize that I had to tell him first – I thought that since we rounded on the patient, and he wanted us to round on the patient, that we were calling the shots. But apparently he just wants us to round on them and not do anything. Absolutely ridiculous. And he definitely could have told me that I did things wrong in a better way than yelling at me for 10 minutes. Plus, he’s a moron – he didn’t diagnose that pneumothorax and I think he was pissed that I did.

So after I calmed down a bit, I called Dr. Gluckman and told him there might be a problem with the ICU doctor. He told me three main things. One, that I probably should have told the ICU doctor first because they are super super territorial. Apparently about two years ago there was a huge fight between the residents and the ICU doctors because the residents were changing the vent settings because they didn’t think the ICU doctors were setting them correctly. And the ICU doctors resented it. I understand their feelings though – I would probably resent it too if a bunch of foreign doctors came in and started trying to tell me what to do. Still, I think this is a stupid system – what’s the point of us rounding on them if we can’t do any management? If we transfer them to the ICU, the ICU doctors should just take over their care. The second main thing Dr. Gluckman told me was related to this – that in general, the ICU doctors resent all foreigners and automatically are biased against them. So it’s difficult for us to get anything done with them. And finally, he told me that they have a problem with women. So being a foreign woman, he probably didn’t like that fact that I pointed out that he didn’t see the pneumothorax on the CXR, even if it wasn’t my intention to highlight his stupidity. And actually, Dr. Gluckman said that he wrote a note (which I didn’t see) saying that if the pneumothorax was stable, we could probably wait until tomorrow to call surgery.

Anyways, at the end of the conversation, Dr. Gluckman said that if I was brave enough to go get the ICU doctor’s number, he was willing to talk to the guy. I told him who it was, and he was a little surprised – he said that he and the guy were sorta buddies! I was a little surprised too. I wonder if I mispronounced the name, or if Dr. Gluckman was thinking of a different guy. So I went back after calming down a bit, and talked to the guy. I apologized for any misunderstanding there might have been, and said that my intentions were not to imply that they were doing a bad job, but to help the patient. He was actually quite civil, but still quite condescending. I know now I should have gone to him first, but it sort of galled me to have to apologize to the guy when he couldn’t even diagnose the problem. And then he had the nerve to say that he did call the surgeon, but he didn’t think it was a pneumothorax!! He was going to let the surgeon make the decision about what to do, but he thought it was a mucous plug! I highly doubt it, and I argued for a brief second, but then I said, well, why don’t you just talk to Dr. Gluckman about it and asked for his contact number. He sorta was like, OH, Gluckman is your attending? And I said yes, because he basically was today, and has been helping me out for the last few days since nobody else on my team has been around. When I talked to Gluckman a few minutes later, he was like there’s no way that is a mucous plug. It doesn’t look like it on the CXR, and plus, this guy has PCP pneumonia, and getting a pneumothorax is actually pretty common in patients with PCP pneumonia.

That wasn’t it – after I finished with that ordeal, I had to come back and the relatives of this comatose guy were all there asking about him. So we had a family meeting (which I was hoping Dr. Stefanski or at least Boipelo would be around for) and I told them the prognosis really was not good. I told them they could meet again with Dr. Stefanski the next day, but I think I conveyed everything pretty well. But it was pretty tough too.

So that was the day… I was pretty drained at the end, and I went home at about 5pm. I felt guilty about that too – I normally stay and help Phil and Lisa out until we can all go home together, but I was drained. I didn’t tell them the story, but I think they understood.

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