PMI WTF

Here's a little convo that took place today between me and my attending in the PICU on rounds today.

Him: Ella, what is the PMI?

Me: The point of maximum impulse?

Him: No

Me: Hmm. The beat of the heart at the apex?

Him: (sigh of frustration) No. Do you even know where it is?

Me: (worried and thinking I'm crazy) I believe that would be the left anterior mid-clavicular line at the fifth intercostal space.

Him: Absolutely not! Ella, you do realize that if you don't know something as elementary as the PMI, BASIC HUMAN ANATOMY (!), that I will have to fail you on this rotation. Its the FOURTH intercostal space!!!!

Me: (gulp holy shit what am I missing????)

Him: Go look it up.

Me: Yes sir.

Him: ( a few minutes later....) Well......? What does it say?

Me: Um, it says the point of maximum impulse is palpated at the left anterior mid-clavicular line at the fifth intercostal space

Him: LET ME SEE THAT!!!

Then, because he was pissed, he pimped me on a bunch of ridiculous shit that nobody in the group knew.

(now to be fair, though the literature does say the 5th intercostal space... I have also seen it as "between the 4th and the 5th")... but for Christ's sake he threatened to fail me over that! And mind you I have no bad history with the guy... it was only my 2nd day working. First day he said "good job"

This med school stuff

Can seriously make a person a little nuts. Today was a call day. Usually the way it works is that as we admit patients during the evening, the med students are assigned patients to see. After we see our patients, we round with the attending, and if we've picked up enough patients we can generally go home. Now, if we meet our requirement by 8:00pm, we can generally go home when we are done. Today, I got mine done at 6:00pm and we finished rounding soon thereafter. I was so stoked about getting done early. But we got a new resident today. And instead of letting each person leave as they finish their work, she wanted everybody to stay until each student was finished. And of course one student wasn't done... and she seemed to be taking her sweet time as well. So I literally had to stay 3 extra hours for no fucking reason whatsoever. Just standing around with my thumb up my ass.

Thats when the "nuts" part kicked in. My brain really started messing with me. Chastising myself for being so stupid as to go to med school at 32. Considering writing my letter of resignation. Wondering what would happen if I threw that large glass bottle of some unknown narcotic across the ED and just went totally AWOL. It was surreal. I seriously had to Buddha Zen my way out of it. It wasn't pretty, folks.

On nurses....

I'm sure this post is going to go over like a match on gasoline... but really... I need to vent. So let me preface this venting session with a couple things:

1) I am a HUGE advocate for treating everyone alike, getting along with everyone, and for doing my best to refute stereotypes in the workplace.

2) I have worked in many hospitals (a dozen in several different states) and dealt with 100's of nurses... so my "opinion" isn't based off of 3 nurses in my hospital.

So here's my question. WHAT'S UP WITH THE EFFIN' ATTITUDE?

Do nurses really get treated THAT badly by everyone that they cannot muster a clean slate when they meet new people? Let me throw out a few scenarios here. All different nurses, mind you.

Scenario #1

Me: Hi Nurse 1. I'm Ella, part of Dr. X's team. Are you patient Y's nurse?

Nurse: Maybe. Depends on why you want to know.

Me: (smile... trying to break the ice) Ok, well when you have a chance he'd like to get his nicotine patch.

Nurse: Don't know why you bother. He's just going to rip it off later.

Me: Well, maybe, but he asked me... so I'd like to get him one while he's in the mood for trying.

Nurse: (Very snotty) Well, YOU'RE just going to have to wait.

Me: No prob. Like I said, whenever you get a chance.

Nurse: Well IF I get a chance I will.

Scenario #2

Me: Hi nurse 2. Dr. X is worried about patient Y and he'd like to get a glucose check right now.... I don't mean to rush you... but I think it's pretty important.

Nurse: JESUS CHRIST! Like I don't have anything else to do.

Scenario #3

Me: Hey is that patient Y's chart? Do you mind if I just sneak this note in there real quick?

Nurse: Is this your patient? Why has he been here so long? He needs to go!

Me: Well, he's got (really bad disease X). And he needs daily treatment.

Nurse: Well, I don't feel sorry for him. He does cocaine, right?

Me: Well, his tox screen was positive... but that's not related to the disease.

Nurse: Well, still. We shouldn't be putting so much effort into him.

Me: Well, that's what we do here. Help sick people.

Nurse: Hmpppfh.

Scenario #4

Me: (trying to get some blank progress notes which have been placed near a nurses desk... and I'm not even in the way or near any of her personal space/ things)...

Nurse: What do you need (attitude 10/10 on the bitchy scale)??

Me: Oh, hey, sorry I didn't realize this was your desk. I am just looking for the progress notes.

Nurse: Well this is MY desk.

Me: Oh. Ok. Well Dr. X said this is where they are kept.... but maybe he was confused. Is there some other place I should get them from?

Nurse: Nope.

Me: Well.... ok...

Nurse: Sigh. Well, go ahead.

Me: Big smile on the outside. Dagger of death on the inside.

Scenario #5

Me: Hi Nurse 5 (who is in charge of LTAC placement). I'm Ella. Dr. X was wondering if you know of any LTAC facilities that will do IV meds for 10 days.

Nurse: No.

Me: Well the problem is XYZ. Can you think of any way that we can deal with that?

Nurse: No.

Me: What about Facility X?

Nurse: No

Me: Facility Y?

Nurse: No

Me: I heard they will make special accommodations as long as the patient is ambulatory. Would you be willing to check?

Nurse: No.

And I can give 100 more scenarios like these....

Hmmm... that's odd

So last week my attending (the rock star woman who is highly respected in the city, university, and medical community) told us that we were some of the best students she had worked with and she gave us (well at least me... can't say for the others, but I assume so) great evals. She even had gifts for us (books with personal notes in them) the following week at class as a thank-you/congrats. THIS week, we have a new attending... who also acts like (and actually said so) he likes us.

However, our new resident doesn't seem to like us. First off, we were supposed to meet her at 7am the first day in the conference room. Which we were all there. And she wasn't. So we waited. 45 minutes later she shows up. Ok, fine. So she's late. No biggie. However.... the first words out of her mouth were "Ok, so my expectations. First, don't be late.". We all kind of looked at her like she's nuts... but ok whatever. Now, onto the end of the week (yesterday).... she pulls the three of us aside and says she has problems with our professionalism. That we should be on time (to my knowledge I have never been even a minute late for anything), and that it is highly unprofessional to be writing anything on rounds (um, so I'm supposed to just memorize everything?)... and that we are so lucky to have her and a "nice" attending because we would get our asses chewed by anyone else... and that she's doing us a favor.

THEN during rounds... the attending asks her a question... something like "What part of the gut does iron get absorbed? I can't remember"... she shrugs her shoulders, doesn't know.... and neither do the interns. Then he asks us, and none of the three of us know either. Then she incredulously says (rather rudely) "Seriously? I mean, you guys JUST took step 1".

Needless to say, I'm a HUGE fan of hers.