Taken out of context I must seem so strange

That's a line from an Ani DiFranco song, Fire Door. It's one of my favorites, and that's one of my favorite lines. I'm not quite sure what it's doing in my head right now, but, there it is.

Today was, once again, long. One of the first things I said this morning was "I absolutely have to get out of the hospital by 5:30 tonight because I have an appointment at 6." Okay? Okay. Except that I ended up calling my shrink at 5:58 saying "Okay, I'm almost to my car so I'm going to be about 10 minutes late..." Fortunately she is both understanding and very near to the hospital.

Many many things annoyed me today, but one that really impressed me was that we talked about the patient who died on Friday at our midday teaching conference. And not in the M&M, dissect out the case and point out where everyone went wrong sense, but to discuss how we all sort of felt about it and how those involved had dealt with it. It was reassuringly touchy-feely. Being a group therapy veteran myself - on both sides of the notebook - I thought this was a fantastic idea. It also helped that I did this death thing a lot in my past life, and that my training surrounding end of life issues in medical school was really good. One of the things I've always pushed for was sort of the CISD model of intervention (critical incident stress debriefing - a model used often "in the field": paramedics, fire, law enforcement, etc - to get everyone together and go though the issues involved in big traumatic events. It's been shown to be a great predictor of who doesn't end up with bad long-term sequellae after badness -PTSD, etc.). But as often as I groaned and moaned and coaxed, I never got this to really happen in the ICU, or the OB floor, etc. Mostly they were devotees of either the "no, really, I'm just going to go on, because this doesn't affect me" school (located near that river in Egypt), or the far worse "I'm not going to deal with it because if I do I'll be admitting fault, and I can't handle that" camp. This really impressed me today. I wished I'd said more, because I almost guarantee I have more experience handling death than anyone else in that room who isn't full faculty. I wished we'd gotten into it a little deeper, but then one of my patients was seizing and I ran off, and having lost the person in the crowd who was likely to keep instigating the discussion, it fizzled. They did use the segue well to go into a useful discussion on the death paperwork as it applies to our institution though, and a little discussion about guidelines for talking to families. It was nice. I need to point that out tomorrow to the powers that be. It's really a shame that the guy died. But I'm glad they handled it well on the group level. And I think both our attendings talked to Mike when it happened. So good.

I'm not sure Mike agrees with that.

We're having an interesting experience of parallels, he and I, right now. I, really like my attending, quirky and neurotic though she may be, and am about ready to strangle Betsy. Mike? Doesn't seem too bothered by Betsy but may have commitment papers filled out on the attending, because he's convinced she's nuts and she's driving him there with her. I obviously loved this little group huddle today; he (and possibly because he was sort of put at the center of it) didn't seem really very comfortable with the idea, or of divulging how he'd handled any aspect of it except the paperwork.

But then, I'm guessing he hasn't spent nearly as much time in therapy - or for that matter, at this point, doing therapy - as I have.

Whatever. Anyway.

As an aside for those of you not in the biz, M&M stands in our world for morbidity and mortality, a conference held regularly to go over cases that had poor or unexpected outcomes. The idea is that it's an open forum to address the inevitable errors that happen and sort out systems errors and improve patient care by learning from our mistakes. The proceedings are protected and even inadmissible in court, in an effort to make it as open and honest as possible. However, people are in fact human and often, particularly in the surgical specialties where the afflicting neuroses are somewhat more prominent, it often becomes a farce of finger pointing and puffed-up armchair quarterbacks with the benefit of hindsight. They an be very illuminating, or horribly painful. I have particularly traumatic memories of one from about this time of year three years ago, where we were discussing this woman who bled at her trochar site after surgery. This woman with a known clotting problem. Who had to take special drugs from hematology to clot her up. Whose bleed clearly must have been caused by the tiny baby dose of an anti-inflammatory pain killer that the intern gave her in post-op, since her hematoma cropped up seconds after she got that injection (read: it had been building for long before the shot, and was likely the reason she needed pain meds; the intern's actions - which were initially supported by the senior resident, unless you'd hear him tell the story at M&M - had nothing to do with it). Bad intern, bad! What was really demoralizing is that they kept referring to me as "the intern." Like I didn't even have a name. Everyone knew it was Ben and Wass and my case, our department wasn't that big. Plus, if you name the other people involved, and just call me "the intern", you know it conveys a message.

Unless you do it correctly. Like "Ben and Wass didn't address the problem staring them straight in the face very much at all, whereas, the intern came up with a very sensible and practical course of action to resolve this problem."

Right. That was going to happen the day we actually had flying monkeys at the Emerald Palace...