El Triste

View from Intensive Care at Good Samaritan Medical Center

I started my inpatient internal medicine rotation two weeks ago. It's the first time I have worked in a setting that includes a hierarchy of interns, residents and attendings. So my boss--the one who will provide a formal evaluation of my work--actually has very little to do with me. It's a process that does not seem quite logical. I have much more contact with the senior resident and the interns, who are all very good at teaching.

My senior resident, Dr. Brian, looks a little bit like, and sounds a lot like Seth Rogen. And not just any Seth Rogen, but the cop-from-Superbad Seth Rogen. Complete with sideburns. Dr. Brian has the kind of laugh that compels you to laugh along even if you're not in on the joke. The mere sound of it infects you.

This work environment is a big transition from what I have been used to. We care for a lot of really sick people. Lots of heart failure. Lots of late stage cancer. Lots of end stage renal disease (Note: never acquire any of the aforementioned conditions. You will not dig it). Also a surprising amount of hard drug abuse (Also advisable that you try to not smoke the meth, 'kay?).

At the end of my first week, I went to Dr. Brian to ask if he had feedback for me. What should I be doing more of? What should I be doing less of? He didn't have much of an answer for me, saying that my documentation was sound. I was taking good histories. I competently examined patients. "Keep doing those things," he nodded. As I was turning to leave, he added, "But," and I turned back to him, braced to hear my failure. He paused, then slowly added, "You should smile more."

Had I heard him correctly just now? That was my feedback for the week? I looked at him sideways.

"Um, are you kidding me right now?" I asked, one part indignant, one part confused.

"Yeah, no. It's totally OK to enjoy this," he said earnestly as he dug his pinkies into his cheeks, forming would-be dimples and pulled the edges of his mouth upward.

I scoffed. "Smile more. Gotcha." So of course I regale this saga to my roommates that night, which produced some hearty LOLs.

Fast forward to Monday, when we needed to perform a spinal tap on a patient. The nurse administered a shot of Dilaudid to ease pain and anxiety. We filed into the room, Dr. Brian in the lead, the junior resident next and me bringing up the rear. I was only supposed to observe this procedure, so I stood near the foot of the bed, hands folded in front of me, watching. The patient looked at me with some alarm and asked Dr. Brian, "Por que eso doctor es tan triste?" ("Why is that doctor so sad?") My mouth dropped open. Dr. Brian, ever the comedian, laughs as he says, "Why is that doctor so sad? Well, I just don't know! I have no idea why that doctor is so sad! I told her she should smile more!"

So of course, this story is also told at the roommate roundtable that night, and I am now known as the one, the only El Triste.

A common scene in Linn/Benton Counties.