In commemoration of that plan, it seems my seven patients have decided to join me in blissful nothingness, if not for the weekend, then at least for the day. As I pre-rounded on each this morning, gathering the "facts", I realized every single one of them were "kicking back" so to speak, with nothing left to do for them clinically (if things stayed their course) than to sit back and wait for them to get better with their respective therapies. However, if I'm really singing the praises of these babies for giving me absolutely nothing to do for them, as I go into my long weekend, then I've gotta talk about Miles, the patient I've had since I started the NICU, my little lesson in doing nothing (see "The Art of Medicine" and "I Hope").
Last I spoke of Miles we were working him up for a "vascular anomaly" in one of his organs that we believed might be causing all of the edema (fluid swelling) in his lungs. Well the report was that the organ was actually fine and normal, which is both a good thing and a bad thing for us. It's a good thing in that this little kid doesn't have another problem to deal with, one that would require a surgical procedure (likely imaging-guided blockage of the rouge vessel if it had existed). It's a bad thing in that his problem is looking more and more like something we can't fix with an actual "therapy" per se.
Since my last update, we have tried increasing the amount of oxygen he gets, giving him inhaled steroids, giving him another diuretic, giving him oral steroids, and even giving him nasal drops for decongestion...none of which seems to do anything for him. Day in and day out, he is still the same. Really all we may have managed to do in trying to fix him is put him at risk for other problems (ie. His therapies gave no benefit, but all therapies have risks and side effects, like the steroid that did nothing to help his breathing but will probably stunt his growth a little).
When I spoke of him in "The Art of Medicine" I mentioned how hard it was to do nothing. It's not just that we are doctors and nurses, with a specific personality type that likes to help people, it's that we are human beings like everyone else. The vast majority of human beings "do" things, when you see this little boy struggle to breath the way he does every day, a regular human being's normal response is to try everything in his/her power (within reason) to help him. My attending's response to all of my suggestions on different therapies to try on this little guy was, "Let's do nothing, he just needs to grow out of it." More and more, that attending is being proven right.
Since he has rotated off, many attendings have taken his place and all like me eventually have gotten aggrivated with Miles' disposition and tried some new therapy to help. One of the attendings that I respect the most, finally today waved the white flag, and conceded that he had gotten impatient (as I had, among others) and had tried to help this child, when all he needed to do was "do nothing".
The nurse who was taking care of Miles at the time made the statement that this little patient had just forgotten to read "The book", meaning that he didn't follow the direction manual for fixing patients that we as doctors and nurses are brought up on (You'll hear this statement all the time in medicine). I had a thought at that moment, that if we were going to go so far as to say that this little guy reads books, perhaps he just didn't wasn't reading the right ones.
"The House of God" is a classic in the medical world. It's a satirical, black comedy of medicine in the 1970's. Although a lot has changed since then (medicine treats it's interns a little better now and we use paper charting a lot less) many of the maxims in this book still hold true. What I was thinking of in particular was the "Rules" of the house, listed in the book by "The Fat Man" (a genius resident in the book). I won't list all of them because most won't make sense without reading the book, but here is the one I was thinking of.
Rule Number 13:
THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.
You can see it is a very funny book from that one statement. However, if it is serious about anything at all, the one thing it tries hard to do is make fun of how inadequate our "health care" is at times and how more often than we would like, we as doctors, have little to do with actually getting the patients better, that is unless you count writing a prescription for more time as a real treatment...
"I'm going to write you a prescription for waiting. I want you to take this with a glass of water, after a meal, once a day at lunch, and then call me at the end of the week if you don't feel better." (insert paid doctor-actor cheezy smile here)
Disclaimer: The FDA is not involved in the testing, monitoring, and/or regulation of chrono-supplements and cannot therefore endorse the effectiveness of said supplements in this add.
Newbie Doc
**FYI, if you check this book out it is an adult book with adult topics, don't give it to any young impressionable minds, without reading up on it first.**
The House of God: The Classic Novel of Life and Death in an American Hospital
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