Tuesday, October 1, 2013
There Is No I In Team
It was as if someone flipped a light switch inside my body. I could feel the sensation rise through the chest, and trample the dazed contents of my skull. Light, however, was a poor, lazy metaphor. There was no heat, only stimulation.
My belly ached from the repetitive heaving that preceded the fever. I envisioned the sandwich I had eaten that afternoon. I pictured small bacteria crowding into the generous dollop of mayonnaise wantonly placed by the store clerk. It was food poisoning. I was sure of it.
I cautiously sipped from the glass of water on the bedside table. My mouth, parched and yearning, was ignoring the revulsion in my mid section. I celebrated the brief ecstasy of quenching the abominable thirst before my belly began to swirl. I got up and ran to the bathroom.
Collapsing back in bed, I looked glassy eyed at my mobile phone which had just begun to ring. I mustered my strength, and picked it up.
Dr. G, It's Lisa at the nursing home, Mr. W's pain is out of control again. I tried the five of roxanol with little effect. His family is getting anxious!
I took a deep breath, and gave a few orders. I then fell back into bed. I had a long night ahead of me.
In fact, my sleepless night came at the end of a long weekend. Not being on call, my family and I treated ourselves to a few days in the city. We swam, we rode bikes, we deserted at Ghiradelli's. Carefree fun in the sun, right?
Well, not exactly. My hour long bike ride was interrupted by three phone calls. While swimming, I had to keep my mobile close in a dry and safe place. And even a hot fudge Sunday couldn't be eaten without some medical question or another needing to be answered. All of this, on my weekend off.
It has become popular to describe my breed of physician as outdated; to say that we have a hero complex, and can't adapt to today's team based mentality. If we would just loosen the reins and hand off some of the responsibility. Groups think better than individuals!
Unfortunately, I have found it all but impossible to "hand off" large numbers of debilitated nursing home patients. The care is too complex, too involved. On the aforementioned weekend, during my little vacation, I had a patient die (expected), and another develop multiple pulmonary emboli. Not to mention the diagnosis and treatment of a slew of new infections as well as a minor fracture.
All of this was managed in the nursing home, with close coordination between staff and families.
When physicians unfamiliar with these kind of patients try to cover, bad things happen. Hospice patients get sent to the emergency room. Demented people get inappropriately put on antibiotics for nonexistent urinary tract infections. The quality of care goes down.
So when I get sick, or take a weekend off, you better believe that I am going to answer that phone call. Because many of those patients are suffering far worse than I. It's not that I am trying to be a hero.
I'm hoping to become the kind of physician that I would want to care for my loved ones.
Posted by Jordan Grumet at 8:27 PM