Morning report. This was when the residents on the three public in-patient wards on the Duke Hospital internal medicine service would meet with Dr. James B. Wyngaarden, Chief of Medicine, to review all of the admissions of the past 24 hours.
The underlying philosophy of the meeting was simple. Don’t screw up in front of the boss.
The exemplification of screwing up would be not having done a Gram stain on the synovial fluid you removed from a patient’s knee joint at three in the morning—just hours before. The patient had been admitted at midnight with a markedly swollen and painful left knee of recent origin. Your job as the resident, was to know within four hours of admission, why the joint was painful and how to treat it. To do that in 1973 meant the extraction of the fluid from the knee with a large bore needle and examining that fluid for uric acid crystals under a special microscope to rule out gout and to stain some of the fluid with dyes that indicate the presence of invasive bacteria, their color and shape. That’s a Gram stain and the saying at Duke was: “I know life is tough, but what did the Gram stain show.” The meaning is obvious. You fight through your exhaustion and complete the work-up. All of it and do it before morning report.
That’s what Monday May 8 felt like for me. I felt like I was fighting all day.
Two days before one of our air conditioners went out. The company who has been servicing our homes for 38 years arrived (late, of course) and proceeded to diagnose our problem as a condenser malfunction and a Freon leak. He charged us for the visit and for the Freon. That was $300. He said that “the fix” for the problem was above his pay grade and we needed a specialist. The specialist arrived (on time) on Monday. He examined the Trane patient. The condenser was fine and there was no Freon leak. The first technician had it all wrong. I guess he was the intern. Rather, the compressor that had been replaced in February was not working again and we needed another new one. With the compressor gone, the readings the first guy got about the Freon were useless. I guess he was, too. We are still waiting to hear when we will get the new compressor. (Spoiler alert: it came on May 12. It seems to be working.)
Later Monday, the pool people arrived. On Saturday, we turned on the heater for the first time since its repair. It worked fine heating the water, but there was a strong smell of gas emanating from the apparatus. This was concerning. The technician found that there were two gas leaks left by the previous technician when he installed the repaired heater. Another intern? I guess.
Are you discerning a pattern?
These service companies send out the B-team first and hope they can do the job. When you discover that they were sorely lacking and call the service company back, they finally send out a competent person. Why not send out the competent person first? Probably because there are not enough of them.
Even though I no longer work, I feel like every new task is a new fight with someone who cannot do it right the first time. Do you feel that way? If so, let me know. I’m accumulating reports to send to Joe Biden so he can ignore me, too like he does the press.
Meanwhile, I will keep up with my boxing training so I am always ready for a fight. They seem to be happening so often lately. The only good news is that none of my fights have involved guns—yet!
Dr. Zwelling’s new novel, Conflict of Interest: Money Drives Medicine and People Die is available at:
on amazon if you search using the title and subtitle,
directly from the publisher Dorrance at: https://bookstore.dorrancepublishing.com/conflict-of-interest-money-drives-medicine-and-people-die-pb/