Thursday, July 06, 2006

 

Sorry Seems To Be The Hardest Word

My career as a doctor is starting off in the ER. I was originally slated to begin in the MICU, which would have been a terrifying experience for everyone involved (just imagine me, after ten weeks of nothing but drinking and reading The New Yorker suddenly in charge of managing the sickest patients in the hospital, most of whom are requiring electricity to aid their breathing). Thankfully, at the last minute, the gods smiled on me in the form of ACGME regulations and I got switched to the emergency room. (I'll now be in the MICU during December, and, according to the call schedule, will predictably be on call all day and night on Christmas.) Although my ER rotation thus far has been incredibly informative and an excellent way to start the year, I should offer some apologies.

First, I apologize to everyone I saw on my very first day who required a prescription of some sort. How was I to realize that the generic prescription pads I had been issued by the pharmacy required some means of identifying myself as a doctor besides my completely illegible signature followed by the letters "MD"? I suddenly became cognizant of this at 3am that night, two hours after my shift ended. This explained the odd feeling I had that day every time I wrote a prescription, as if I knew something was not quite legal about the process, but couldn't articulate where the flaw in my design might be. I especially apologize to the man with excruciating testicular pain of unknown origin for whom I prescribed a three-day supply of Vicodin until he could follow-up with his PCP. I guess what doesn't kill you only makes your stronger, huh?

Secondly, I want to apologize to the 68 year old woman who came in with a swollen left cheek, and who I tried to convince that she must have just slept on her face wrong. In fact, she had an enormous dental abscess, the presence of which I should have been clued into given her horrendous dentition and the pus filled pocket emanating from her gum line. Instead, I asked her 15 times if she was sure she didn't fall down before going to bed the night before and then basically decided that she was probably mildly demented and/or intoxicated and didn't remember what happened. For some reason, I was also convinced that this all had something to do with a pointy nightstand. I apologize also for failing to use a tongue depressor during my initial mouth exam and instead just kind of poking around with my finger. That's disgusting. Seriously, though, shouldn't a dentist be seeing this patient? The attending asked me which number tooth was involved. Teeth have numbers?! When did we learn this? Was it before or after the sketchy dental resident started hitting on the first year females?

Perhaps the largest apology I owe is to the numerous people I have rectalized over the past two weeks. You know who you are. Even more deserving of my guilt are those I had to perform multiple rectal exams on because of errors I made in the initial process. To the woman with a history of gastric ulcer who presented with melena, I'm sorry I didn't go deep enough the first time. To the nursing home paraplegic patient with colitis, I'm sorry that I accidentally smeared the sample on the wrong side of the guaiac card. To the young man with a Dieulafoy's ulcer, I'm sorry I failed to realize that there were no cards in the room until after I performed the exam. And to myself, I'm sorry that I took off my glove prematurely after my very first exam, and was holding the guaiac card in my bare hands asking an attending to confirm the negative result before he pointed out to me that I should wash my hands twenty times over. Again, that's disgusting. Additionally, I apologize for the fact that I can never remain completely silent during a rectal exam and instead either make an incredibly awkward comment ("This is why I became a doctor" or "This is less fun for me than it is for you") or make oochy-ouchy noises reminiscent of everyone's favorite gynecological surgeon.

Finally, I apologize to the wonderfully warm and charming man who came in complaining of right upper quadrant pain at 9pm and to whom, at 3:30am, I had to break the news that he had a huge pancreatic mass with probable mets in his liver. I'm so sorry. You broke my heart and I broke yours. Good luck.

Comments:
Brother,
What of your tattoo'd RN and all the others that cleaned that finger, brushed off your knee's, and held down the psycho who was about to thrash you. Check out Bhodi_RN on Xanga my brother...I'll keep you abreast of the ER HELL.
 
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