werner@aecom.UUCP (Craig Werner) (11/23/85)
[#1 Well, thanks to your letters, I can now be assured that at least 16 people
read these excerpts, so they will continue as my time permits.]
[#2. One person asked me to designate the excerpts, so they would definitely
avoid 'n'ing them. Despite the fact that so marking leaves open the
opportunity to 'n' everything else I write with impunity, I will comply with
the request. Hence, POMM stands for A Piece Of My Mind, and they'll be
numbered.]
[#3. I have mixed thoughts about the next piece, would like some feedback.]
A Piece of My Mind
JAMA, March 8, 1985, 253:1402
Not on My Shift
She was a 72 year old woman who had been recently transferred
by helicopter from a smaller hospital. She had started bleeding from a
duodenal ulcer and was in serious condition. The attending surgeon and
medical consultant both agreed to try agressive medical management because
of the risks of surgery. But she continued to bleed despite treatment
and was taken to surgery that evening.
It was a Saturday night, and I was getting a report from the
surgical resident who had been on call the previous shift. "We had quite
a time with your patient last night," he said. "She survived the
operation, but I think she'll probably die sometime today."
"Not on my shift," I blurted out without thinking.
As I went through my surgical rotation in medical school, and now
in residency, this situation had come up many times. There was always
one patient on a service who was close to death. The residents did
everything possible not to let that person die on their night on call. It
was inevitable that the patient would die, but to let that person die on
your shift was a sign of failure.
My night on call started as usual: an admission from the emergency
room to rule out appendicitis, a traffic accident victim with only
superficial wounds, a few calls to the floor. Then I was called to the
intensive care unit. My patient's blood pressure was dropping, and her
urine output was low. From that point, I was in and out of the ICU all
night; increasing her fluids, transfusing blood, adding a dopamine drip,
inserting a catheter and an arterial line, giving albumin, putting her
on a ventilator; it went on and on.
Finally it was 7 am, time for me to give the report to the next
surgical resident. I described the evening's work with my patient and said
that she was in serious condition, that I thought she would probably die
during the day.
The oncoming surgical resident flashed back, "Not on my shift!"
Lynn A Crosby, MD
Omaha, Nebraska
--
Craig Werner
!philabs!aecom!werner
"... Has Determined That Cigarette Smoking Is Dangerous To Your Health"abc@brl-sem.ARPA (Brint Cooper ) (11/26/85)
You solicited reactions. Here's mine. If ever I'm in your
care for a critical situation like the one you described (or,
as is more likely, for a myasthenic crisis in which I can
neither breathe nor swallow my own saliva) I hope you do
all you can to keep me from dying on your shift. And I hope
your collleagues do the same!
--
Brint Cooper
ARPA: abc@brl.arpa
UUCP: ...{seismo,decvax,cbosgd}!brl-tgr!abc