The January Blues

Ahh, winter.  There's nothing like it.  I love this time of year, it's when the air is crispy and you become more appreciative of sunshine (and feel the effects of neglecting your vitamin D / calcium supplements).  I love winter very much, it's when the whole world can feel transformed in a few hours to a white wonderland, into which you wander with oversized hats and crocheted scarves.  But, every year, I start getting very depressed around January, most likely due to a combination of lack of exercise, vegetables, sunshine and generalized explosion of personal problems.  I always get blue around this time of year, and I never figure it out until I'm well deep into it.  This year, I heard snatches of Billie Holiday on the radio singing "Gloomy Sunday" and I finally figured it out.  I have the blues.

It's a magical time of year for other people, too.  The roads are slushy, the sidewalks are icy, the wind is knife-like.  Not surprisingly, so are the people in the hospital.  I first noticed it with the nurses back at Shmanhattan - every time I smiled back at a nurse or wished them a nice day, I only got stares or dismissive expressions.  I thought, at the time, that it was because it was a fancy Shmanhattan hospital, and people are just ruder when something is nicer.  But then, I remembered that I live in Queens, where drivers routinely stop at red lights and then careen right on through anyways.  So that couldn't be it.

It was the end of the day, and the surgery team decided to get together and do table rounds in the resident lounge, to review the day's events and update the patient census.  I had been holding the on-call pager since I had the least number of patients, but instead became the busiest person because I received non-stop calls on the most ridiculous things.  When I presented the day's events for my patients, I was met with underhanded comments which indirectly mocked my hard work to get done what I could.  I kept my mouth shut, and observed that multiple similar comments were being made around the room, with everyone giving off a sour face and nobody appreciating anybody else's efforts.  In the middle of these tense rounds, a nurse decided to page me multiple times regarding a patient needing a medication.  I spoke with her and clarified that this was a patient who was already discharged and merely awaiting a ride home, and that she was in no acute distress, just needing a renewal of a medication for pain.  I tried to tell her as politely as I could that we were rounding, and that I would send someone up to write the order renewal as soon as possible, but her only response was "Well, my patient is in pain, and that's all that matters".  I received the same page from the same nurse twice more, still while rounds were occurring (and conveniently increasing the anger of my seniors), who finally sent me upstairs to sort out the matter.

I found the nurse and tried to pull her aside from the nurses station to discuss the issue privately, and remind her that residents cannot leave rounds just to address one patient's needs unless it is an emergency.  She instead responded by avoiding my eye contact, and repeating her same lines over and over, without listening to me at all.  I said that we should discuss the issue as a group, and for the first time ever, I got into an actual tiff with a nurse requiring a nurse supervisor's intervention.  The supervisor was extremely professional, listened to both of us and tried to assuage the nurse's concerns.  I explained as best as I could that we were responsible for many patients, and a proper uninterrupted sign-out round is essential to maintaining safety and continuity of care.  Instead, she avoiding my eye contact again, looking away at the ceiling, much like a 7 year old.  I finally had to conclude the session by reminding her that the extra order was now written, and walked away without any peaceful resolution effort on her behalf at all.

I felt terrible.  Normally nurses love me, because I try really hard to be as polite as I can and show appreciation for their patient advocacy.  I went home feeling upset and wondering if I could have handled things differently, but seeing that the nursing supervisor agreed that I had escalated the issue in an appropriate way, I couldn't find any different avenue.  I started to wonder if there was something in the water the following morning, when our team met to review surgery content material.  I didn't even know what the tension was about, but suddenly I looked up from my patient list of to-do's to see two residents making tense loaded comments to each other.  I left the room to assist another intern with a blood draw just as shouting commenced in front of a room of students and residents from other programs.  It was embarrassing.  I just couldn't figure it out.  Even if people have legitimate reason for disagreement, to argue in front of people you set an example for in a hospital is just crazy.  That tension extended to the remainder of the day, to the point where I could feel items not being mentioned in sign-out just to avoid further conversation.

I think everyone needs to take their vitamin D.