Playing Doctor

Initial Visit?

Tuesday, January 24

El Baile del Perrito

The MICU resident, Dr Pasteur, is explaining to me why he’s not taking the emphysema patient onto his service.

‘I talked it over with the ED and we all think she’s stable,’ he says. ‘Did you see her blood gas?’

I frown. I explain my interpretation of it, but he doesn’t buy it.

I consider asking him to page his attending and discuss the case with him, knowing the attending will side with me. But I don’t have the stomach to be such an outright asshole to a friend.

‘Just keep a close eye on her tonight, will you?’ I say, after more discussion, finally relenting.

But then, after saying that, I cheat. Pretending to trust him to watch the patient, I write my admission orders in such a way that she will not be allowed to be moved to her hospital bed. Stuck in the ED overnight, the ED docs will see her deteriorate and be able to intervene.

My interns and I finish our work and sign out our patients, turning over the collection of pagers we carry. I explain to the overnight physician why I had written an impossible order for the emphysema patient. I tell him not to change it and defer any questions to me in the morning.

Then I get in my car, throwing my white coat and stethoscope in the trunk, and head to the bar to meet Birmingham for a beer.


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