The Blinking Light
There is one ICU attending that stands out from the rest, Dr. Smith. She is very tough, very demanding, expects excellence from those around her at all times. The senior residents had warned us about how tough she can be, that she had been known to make a few residents break down in tears on a few occasions. I know that I myself was very intimdated, if not afraid of her, when we started out this past fall. But now, having gotten to know her a bit better, I actually really enjoy working with her. She IS tough, IS demanding, but I also know it’s making me a better doctor. Things she has scolded me for in the past, are things I didn’t get wrong the second time around. By nit picking our notes each morning on rounds, we learn what we need to be looking out for, to be aware of, what information we are missing out on. I can see how people might take her criticisms as personal attacks, but when you view it as her trying to make you better, suddenly it’s not such a big deal, and then when you realize that there is this dry sarcasm underlying most things she says, her criticisms actually start to become quite funny, especially when you can play off them and get a laugh out of everyone, including her, on rounds.
She is equally tough on the rest of the staff, nurses and aids alike, and some of them may not appreciate her criticisms for their constructive nature as well as some others are able to. I say all this to set up this next little story. About 4pm one afternoon, this patient comes up from the ED, bradycardic to the 30’s, pretty much obtunded. I dropped a cortis into her internal jugular ( basically a huge needle in her neck) and she didn’t flinch once during the whole process. She was stabilized and what not by the time I left that night, resting peacefully. I come back the next morning and even before I get to the unit I hear a loud voice booming down the hall. Upon entering, I hear calls, at the utmost top of voice volume coming from the room where the obtunded patient was the night before. “DOCCCCTOOOR! NUURRSSE! THE LIGHT IS BLINKING! THE RED LIGHT IS BLINKING! THE RED LIGHT IS BLINKING!” I walk up to the overnight intern, “What happned to the obtunded lady in that room from yesterday, did she pass or get transferred out?” “Dude, that IS her. She has been screaming about that damn light since 4am non stop”. ” WHY IS THE LIGHT BLINKING? DOCCCTTOOOR IS THERE A FIRE? NUUURSE! I SEE PEOPLE WALKING BY MY ROOM, DON”T FORGET TO EVACUATE ME!”
Apparently her mental status had improved a bit since I left the night before. The patient was in no apparently distress now, just a bit delirious, which was not entirely different from her baseline from what we were told. If you have never worked in medicine, there are few things more distracting and frustrating that a patient repeatedly calling for help when they have nothing that actually needs help with. The patient had been redirected and reoriented multiple times since 4AM, to no avail. 2 of ativan and 5 of haldol didn’t touch her one bit. She wasn’t complaining of anything other than the blinking light, but the second you walked out of the room “DOOOCTTOOOOR! NUUURRRSSEEE!” So the nurses thought it would be kinda funny to try to get her to call for Dr. Smith specifically, as a way of getting a little revenge for all the times Dr. Smith had been tough on them. Imagine what it would be like to have someone shouting your name over and over and over at the top of their lung. So every time they went into the room to see the patient, they would remind her that her doctor was Dr. Smith. And before long the patient was repeatedly calling ” DOOOCCCTOOOR SMIITHH! THE LIGHT IS BLINKING. DOOOCTTTOOR SMITHMAN! DOCTOR SMITHMAN! HELP ME DOCTOR SMITHMAN” And it WAS pretty funny….for a while…but when the patient was STILL shouting it 12 hours later…the joke had worn just a bit thin. And by then Dr. Smith had gotten the patient to learn all of the residents names as well, as her own form of payback. At one point I was dropping another central line on a patient on the far side of the unit, only to hear my name being boomed from the opposite end. Everyone was relieved when psych finally made it by and recommended 5 of haldol Q20min, which brought her voice down to a nice conversational level. Thankfully she was finally transferred off the floor before my next shift.