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It’s 2 a.m. and I’m really tired. I’ve been on nights in the cardiac intensive care unit for a week straight, averaging 5 admissions per night, and getting even less sleep. At this point, I am far from my usual, cheerful self. During a merciful lull in the action that is the CICU, I finally have a chance to run down to the cafeteria and snatch up the last piece of remarkably bland pizza. Settling in for that first regretful bite, I’m greeted by my favorite noise: beep, beep, beep – beep, beep, beep. 

Great, I think; which patient is going downhill now?

I call back the number, wait to be transferred to the nurse who paged me, and sluggishly ask, “What’s going on?”

On the other end, an exasperated (and likely equally fatigued) nurse informs me that the patient in room 3 is having a nosebleed and the intern is in another tower dealing with a patient who had earlier been transferred to the step down unit. Letting out a deep sigh, I throw my food down, emerge from the call room, and pop in to see the patient. With the way my week is going, I am expecting the kind of massive epistaxis that we often see in patients on anticoagulation. Instead, I am greeted by a pleasant elderly gentleman holding a piece of tissue paper with several drops of blood on it. He goes on to inform me that his nose was dry, he was picking it, and it began to bleed. But, “It’s all better now.” I look over at the nurse standing sheepishly at the doorway and listen as she acknowledges that she was too busy to evaluate the nosebleed before calling me to evaluate. To be honest, at this point, I am pissed. I could easily yell at her, remind her how busy I am, and storm off in a dramatic show of frustration. Part of me certainly wants to.

So, what happens next?

I am far from a saint. My wife can confirm that. I have been prone to outbursts and have certainly said my share of inappropriate things over the years. (You probably wouldn’t want to listen to me when caught in a traffic jam. Sorry, Mom.) Unfortunately, some of these outbursts have extended to the professional setting. Looking back, it is something that I am not very proud of and several moments stick out as particularly embarrassing. As an intern, I remember being paged by one nurse in particular asking if it was okay for her to give a patient Tylenol for a headache, despite the fact that the patient’s primary team had ordered it as a prn medication earlier in the day. Yet while a simple “yes” would have been sufficient, I made it a point to walk down to the nursing station and condescendingly explain the concept of prn medications and why pages like this “ruined my life.”

Wow, what a douchebag, right?

Fortunately, nothing came of this incident, but it easily could have. I spent the next three nights on this rotation noticing the disapproving faces of the rest of the nursing staff who had undoubtedly heard about my unprofessional outburst. I sat around thinking, what if they don’t call me for something important now? What if something bad happens because of it?

Somewhere along the way, I began to pick up on the importance of being a leader and acting like a professional. I learned that healthcare is not a one person job, but rather, a team effort. As a physician, you will often be looked to as the leader of that team, and how you lead is completely up to you. Do you want to be an asshole that berates people for mistakes or belittles others for your own amusement? Or, would you rather encourage a productive environment that allows those around you to succeed? Doing the latter doesn’t have to mean avoiding conflict and pushing problems aside, but it does mean that you try to handle it in a professional way and try to look past your personal feelings. What could seem like a stupid question from a medical student, nurse, or intern is often times someone just trying to do the right thing for their patient and looking to you for assurance.

Back in the CICU, I am still standing at the patient’s bedside and yeah, I’m still pretty pissed off. I can tell that this nurse knows I am upset and judging by her body language, she is certainly bracing for the worst. It’s almost amusing seeing the look of shock on her face when I shoot back, “No big deal, you’ve been just as busy as me tonight. Call me if you need me.”

I walk out of the room, offer her one last smile, and head back to my call room. Sitting down, it’s finally time to enjoy this bland, and now cold, piece of pizza. Then, “beep beep beep, beep beep beep…”

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Dr. Christopher Carrubba

Dr. Christopher Carrubba

USMLE Tutor & Senior Contributing Editor
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