living, learning, being a dumbass

Well, here's the truth. I'm getting my ass kicked. Right out of the gate. It's not that I thought I'd be all over it, or anything. I just didn't expect to have them waxing the floor with me. Me and the Burmese guy with the not-so-hot grasp of colloquial English. So this morning, I had seen my first patient, a lovely young woman from Africa with TB. I've been waking her up every morning at 7am for nearly two weeks now to ask her about cough, fever, pain, etc, and she's ever so kind about it. Half-way through investigating my second patient (and to me, it all seems like a mystery to unearth each and every morning -- there is no easy way for me, lowly student, to get a succinct report from, say, the primary team intern or resident. Talking to me is a waste of everyone's time. So I have to skulk around, eavesdrop, try other people's passwords to the roughly 31 computer programs that conceal various pieces of patient data. Not that I'm bitter) the resident looks at me (is that a smirk, Dr. Dear?) and says, "Well, we have 5 consults today, so you do this one." My heart sinks just a little, because my last new patient presentation was an unmitigated disaster ("What medications did the patient receive in the ED?" "Umm...." I mean, how does a normal doctor-ish person fail to note that somewhat interesting fact? Well, I was running between floors looking for a computer to look at the lab results and print out the EKG, but still...), but I want to REDEEM myself and here is the opportunity. So in the panicked one hour and twenty minutes remaining till rounds, I finish up quickly with patient #2 (heart failure, hypertension, diabetes, TB, gout, and I think I'm forgetting something) and vow to get all the dirt on patient #3 (HIV/AIDS, chest pain and shortness of breath, probably PCP). And I do! I do! Except for the CT, but that hasn't even been read yet, so you can't really blame me (or can you?). Feeling almost proud of myself, especially when I realize that I have three patients and the real interns on the pulmonary service only have one or two. See, see, I think, I can do this. I'm not going to be a total failure. But pride, as you may have heard, goes before the fall. A meeting later, discussing all the TB patients. One of the public health nurses turns to the doctor and says, "Oh, we can't discharge patient #2 until he gets his pacemaker." Dr. S does a funny (well, comical) double take and said, "Pacemaker?," and then looks right at me. See, I told him this morning that nothing exceptional had happened over the weekend with patient #2, and things were going pretty well (for somebody with a bad heart, bad lungs and gout), because there was nothing in the chart. Really. I had no clue they were going to put in a pacemaker. It wasn't in the orders. It wasn't in the cardiology note. But someone, somewhere knows the plan, and that someone is not me.
You know, writing it out now, it doesn't seem like quite the big deal it seemed at the moment (one of the other attendings said, "Oh, look at her face," as I did a double take of my own). I almost cried. There's a lot of pressure to know everything. Even things you can't possibly know. It's not like I'm the person who's supposed to put in the pacemaker, for god's sake. But, the thing is, of course, that to take care of a patient is to take care of that person -- not just his lungs and the TB meds that will keep them from getting all grody. I'm not sure I'm up for it, frankly. It's discouraging to have to make each and every mistake just in order to learn from it, but it looks like I'm on my way.