Monday, January 03, 2005

The Emperor

After a beautiful month in outpatient medicine I have returned to the train wreck otherwise known as the Coronary Care Unit. There are problems...

What do you do if the man who built this house is your Attending? What if that same man is your attending in the Coronary Care Unit? What if that man, in the CCU, has a large degree of senility? What do you do?

I understand the *Commish is aware. The administration has been “discussing” this for the last few weeks. They understand that two second year residents will have to run their critical care unit. This is what you do when your attending is a *Giant and has dementia. The burden falls on the rest, who lack competency for different reasons. The real problem is that no one tells the emperor he has no clothes.

I am unsure of myself, expected to be unsure of myself, only a second year resident. Call consults from the entire hospital and follow smarter advice. Attending can’t help, with dementia and respect. He’s become too proud to hang up his stethoscope.

My attending is a danger to these critically ill patients. He is a danger to our careers and a danger to the hospital. And everyone knows. So where do I turn to? If I call the authorities they will know it was me. Talking to him directly may get me in more trouble than it’s worth. It’s not my responsibility to go head to head with this *Giant, there are others more capable.

Dementia, senility, and lacking competency in the intensive care unit. This Attending is a legend who’s time has past, unfortunately. The Emperor has no clothes and those responsible to tell him have become extraordinarily blind.