Panic

Today it happened. I knew the moment would come, but I never expected it to be today. A universal rite of medical training is the terror you experience the first time you have sole responsibility for a patient. I once went to a lecture during my postbacc titled "Medical Students' Dreams." I was obviously drawn by the whimsy of the sentiment - what goals and aspirations could my peers have? - only to be disappointed (and fascinated) when the true content turned out to be an actual interpretation of medical students' sleep dreams. What the speaker found was that nightmares peak during the third year, particularly the beginning portion, and he hypothesized this was due to internal conflicts surrounding our newfound (sense of) responsibility. I understand now what he meant.

Obviously, HIPAA prevents me from discussing the case. Suffice it to say there was a moment in time this morning when I realized my patient was in a bad way. And this was followed by a moment of realizing that I was the only one who knew. Without being too melodramatic, only the cosmos and I knew what lay in store for the patient and yet I was at an utter loss for what to do or who to tell or how to tell. And so I wandered around for 10 minutes, panic mounting as I tried to reason my way through their symptoms. 10 minutes of meta-analysis, of trying to soothe my panic with reassurances that what I was feeling was normal and to be expected and that I knew it was coming. 10 minutes that this patient might die or suffer irreversible damage if I failed to act appropriately. And I didn't know what to do. A brief stroke of luck later, the Attending appeared (after I had found my resident and had just begun to explain my worries about this patient), and I waited while another resident on the team discussed their patient. And I struggled with the idea of interrupting - how much of an emergency was this? I didn't know - not wanting to be rude but panicking that my silence was a terrible decision. And then the clouds parted and the sunshine peaked through and I screwed up my courage and I politely and quietly said, "I'm really worried about my patient. Please come verify that what I see is correct." And they listened. And they followed. And they agreed (to an extent). And I did the right thing. And I made a difference. (And of course, the beast that is The Hospital was busy eating its other patients and I am not sure how much care my patient has actually received since this morning.)

I have a motto I stole from a friend. Each and every one of us should strive to be SICK. Cultivate within yourself Self-discipline, Integrity, Courage, and Kindness. For the last few years I have focused on Self-discipline. Discouraged, this year I chose to focus on Courage. I'm proud of my courage today.