Posted by The other day, I let our medical intern in the ICU place a dialysis catheter on one of our very sick patients. It is a minor surgical procedure of placing a thick catheter in the patient’s jugular vein using ultrasound for guidance. Of course she had lots of supervision, as one of our senior resident was assisting her, and I was around as well for support.
The intern was not able to place the catheter that quick being inexperienced, so it took a little longer doing the procedure. Though that is nothing out of the ordinary. This is normal for a teaching hospital, as interns and doctors-in-training has to start somewhere.
While we were doing the procedure, the patient became unstable, and then went into cardiac arrest. We called a Code Blue (a call for help on a patient having cardiac arrest). Moments later the whole room was teeming with hospital personnel responding to the code.
The patient survived and was stabilized after several minutes of furious cardiopulmonary resuscitation.
The intern was visibly shaken to what just happened. I saw her later in the workroom crying. One of the senior resident told me that the intern felt that it was her fault that led to the cardiac arrest.
However after extensive work-up, we found that patient has a weak heart to start with, and in fact was in congestive heart failure and kidney failure, and that was why he was in the ICU. Then he suffered a heart attack, that caused the cardiac arrest. It was just coincidental that it happened while we were placing the catheter. It was not a direct complication of the procedure.
I reassured the intern that it was not her fault, and gave her some words of encouragement, that this is all part of our work. Besides, this intern is good, intelligent, comes prepared on rounds, and has initiative to learn. I see a great potential in this young doctor. Her only fault is that she is new and inexperienced. But we all have been there.
I have been an attending physician in a teaching institution for a long time now. In fact five of my partners in our practice, who are now full pledged Pulmonary and Critical Care doctors are once my medical interns in the hospital. So at some point in time, I showed them the ropes. And now they are probably better than me, and once in a while I asked for their opinion in difficult cases.
I remember when I started my medical internship in a Columbia University-affiliated-hospital, I was not a “good” intern. At that time, I was a new arrival to the US from the Philippines, was new to the American system of medicine, and definitely not the sharpest among our batch. Compared to our star intern, a graduate of Johns Hopkins University, I was like a kindergarten. I was really lost and I struggled in the beginning. But I am thankful for my seniors and attending physicians who saw the rough potential in me. Though I would be lying if I tell you I was not lectured on at times, or even chewed and spewed.
At the graduation ceremony of my Internal Medicine Training, they gave me the “Tabula Rasa” award. It took me a while to figure out what it meant. But I guess I was really like a “blank slate” when I started, which what the Latin “Tabula Rasa” means. I must also had that blank stare like a deer in the headlights, that goes with my blank mind.
But as I said, we all have to start somewhere.
In some academic centers they have a very defined hierarchy. Even one year of seniority feel like a world of difference. The attending physicians act like demigods as they would climb up their high horses when they do their rounds. The attendings treat the medical residents as dirt. In turn, the senior residents treat the junior residents as dirt. The junior residents treat the interns as dirt. The interns treat the medical students as dirt.
It may be hard to admit, but I witnessed this hierarchical state of thinking when I was in my medical school in the Philippines. And being the medical student, I was at the bottom of the totem pole.
But I don’t buy into this old-school hierarchical philosophy and system that treats our inferiors like dirt. I adopted a philosophy of providing a more collegial environment which I believe is more conducive to learning even for the least of us. A resident, or an intern or even a medical student can approach me freely without fearing of being chewed on.
Back to my intern, I hope she’ll learn something from that difficult day. I know someday she will become a good, experienced and a well-rounded doctor too. And if someday she becomes the chief of the medical staff in this hospital, as she has a great potential, or becomes the head of a big-shot medical corporation, or even becomes the US Surgeon General, I hope she remembers me and the words of encouragement I gave her during one difficult day.
(*photo taken from reddit.com)
Pinoy Transplant in Iowa 
I too abhorred the hierarchy you described. It was such a silly ego-driven game. But I saw quite a few people thrive on this set-up. I never ascribed to it.
I have no doubt some thrive on this. Do you remember when we were medical clerks, when a demigod or certain attending will make his rounds, the residents would even practice us on how to answer, or where to stand, and ladies put on make-up, and one even assigned just to fan the attending because it is hot in the charity wards. It’s pomp and circumstance.
I did not have it that bad. But I did make the mistake once of giving the right answer to an attending after a resident failed to answer the attending’s question during morning rounds. I was a lowly medical clerk then.