Saturday, June 14, 2008

Weekend Rounds

I actually like coming in for rounds on weekends. I usually start early, around seven or so. The drive in is quiet and pleasant and I keep the windows rolled down and the fresh morning air all around me. The parking garage is nearly empty at this hour on a Saturday. I don't wear a tie; sometimes just a short sleeve Polo collared shirt under my white lab coat. The halls and lobbies are devoid of people. It's quiet. The bustle of action and people passing and trying to get somewhere fast is gone. There is a distinct lack of pace and urgency to the hospital that is quite refreshing. Remember when you were younger and you had to go into the middle school after hours for a practice or a meeting? How different and strange and interesting it seemed without the usual regimented fuss and human traffic? Weekend hospitals are similar...

I take my time. I visit with the nurses on the floor. Review the morning labs and vitals on the computer, sipping a large starbucks. There's no rush. I can spend some time with the patients. There're no cases to be done, usually. No office appointments. I can afford to review old CT scans, lab trends, variations in vital signs, the sort of things you sometimes miss or forget to check during the week when you're always running a little behind. It's a way to get caught up, reacquaint myself with all the little details on the patients.

Rounds are enjoyable. I usually examine patients a bit more thoroughly. I even use that thing that internists have hanging around their necks...a stethoscope, right? All dressings come off. Wounds are inspected. Stoma appliances are removed so I can see the cloaked beefy red bowel exposed at skin level. I look for erythematous IV sites and forgotten triple lumen catheters and foleys that have been left in too long. It's my chance to leave no stone unturned.

A lot of times, I'll pull up a chair after the exam is done. You can get a sense of how someone is doing, how he/she is really doing, by moving the conversation beyond the usual litany of "do you have pain, are you nauseous, have you pooped yet"...It's fun to shoot the breeze. Find out what interests them. What they like to do outside the hospital. The Nascar fanatic. The single parent divorced lady going to night school for her masters degree. The kid who works at the corner Subway. The guy who brags that his wife never had to buy a tomato from the grocery in 50 years of marriage because of the fecundity of his yearly backyard garden. I especially love finding out what old guys did before they retired. Policeman. Pharmacist at the drug store where I frequent. Math teacher at the local high school. The people who used to be all around us every day, the ones that time has passed by. I'm reminded that all these people stuck in the hospital on the weekend have lives, families, places and things they'd rather be doing. The least I can do is listen to them for a few minutes. You see, I get to eventually drive home in my truck. They don't. The weekend isn't a time to escape and relax for everyone. And that can be frustrating as hell. There's the lady on post operative day #6 after a colon resection with an ileus and the annoying nasogastric tube who thought she'd be home three days ago. She needs me to sit there in that chair holding her hand for an extra fifteen minutes, telling her she's not unusual, that everything is going to be all right. I owe her that. To a certain degree, there's a loss of one's dignity during hospitalization; all the shiny wood floors and smiling faces and fresh architecturally exquisite hospital lobbies can't mask the fundamental fact that you've been institutionalized temporarily. And the weekend can sometimes make it seem worse. Too often, I've seen docs try to whip through rounds on weekends in a half hour or so. Kids soccer game to get to. Or a barbecue. Or a Browns game. Weekend rounds are an underrated duty but I think the patients appreciate a doc who takes it seriously and it's one of my favorite parts of being a surgeon....

11 comments:

Theresa said...

I love weekend rounds. Our daytime hospitalist shifts switch on Thursday, so Thurs/Fri are hectic and Sat/Sun come as a great relief. There is great camaraderie among hospital staff on weekends, and holidays too.

Appreciate the tone of this post--it is really wonderful to hear one of us enjoy their work. I usually do.

btw, I linked to you on my blogroll.

Anonymous said...

What a fantastic post!

I can completely relate. The fact that the "rest of the world" has "stopped" gives you a chance to take the time to do things exactly how you wish.

I am in a different pressure packed field, but I feel the same way when I come in to work on weekends.

Jeffrey said...

wow. you're the kind of doctor i want to be next time. thanks for sharing. im sure your patients deeply appreciate the extra time u spend with each one of them.

Joan said...

Hope I get someone like you! That's all we patients want--a little understanding!

Dr. Val said...

Your weekend rounds are similar to the daily life of an inpatient PM&R doc. ;) We are one of the few specialties that have the luxury (nay duty) to get to know our patients' social histories. Only thing is, we get paid a lot less than surgeons.

Great post!

I blogrolled you. :)

platensimycin said...

admirable!

Anonymous said...

Sadly, this is how rounds should be every day. excellent insight
drmatt

inaudibleaudible said...

Your blog is like the show scrubs, only if scrubs were funny and insightful.

Anonymous said...

and should we consider your comment "funny and insightful", Inaudible?

Anonymous said...

Oh my gosh, that sounds so nice and well, sweet! Come work at my hospital won't you? It would be great to have more docs who would actually spend more time with their patients--seeing, listening, looking. Some docs wear stethoscopes but never actually use them... I swear some just make up their assessments...

Thanks so much,
I just found you today,
Just finished a shift,
An Indiana RN

Anonymous said...

Perhaps the doctors rushing through their weekend rounds are the ones who have not seen their families all week and so need to make at least one token effort to see them