Home Commentary The Resident (with apologies to Edgar Allen Poe)

The Resident (with apologies to Edgar Allen Poe)

February 2012

Published in the February 2012 issue of Today’s Hospitalist

ONCE UPON A MIDNIGHT ADMIT, while I pondered the ER’s logic
Of admitting this great-looking kid with a swollen node,
and I nodded, strategically napping, suddenly there came a knocking,
knocking on my on-call room.
“Tis the student,” I muttered, “tapping on my on-call door;
only this and nothing more.”

Ah, distinctly I remember it was a bleak November
and each dying page wrought my gastritis to the fore.
Eagerly I wished for the morrow, and the pancakes I adored
from the lovely cook Maria, at the cafeteria off the floor.

And the napping interrupted
by the tapping, and the heartburn worse than ever before,
so that now my heart fisted with pain, I stood repeating,
“Tis some student entreating my on-call door,
some late H&P that needs my reassurance.
This it is, and nothing more.”

Presently, my soul grew stronger; hesitation then no longer.
“Hey, you!” said I, “or, scut monkey! What you may be I don’t know.
But the fact was, I was napping, as my old age now requires,
and you came knocking on my door, when you should be knocking
the senior resident’s door, who should be awake and working harder.
Not harder than the intern though, as surely they’re all well rested,
as their working hours are restricted.”
Merely this and nothing more.

But as I opened the door, there was nothing.
A breeze fluttered my dirty white coat
and as I stumbled through the ward, looking for the student,
in there stepped a stately resident of the present days of work.
Not the least obeisance made he, not a minute stopped or stayed
but sat in his chair in front of a computer, looking
at Epocrates or UpToDate,
with lists of patients filling the pockets of a crisp,
well-pressed doctor’s coat,
perched and sat, and nothing more.

Then the resident marked my coming with an unabashed smile
at my disheveled hair and blood-stained scrubs. I said,
“Though you be sitting there, admiring
rows of numbers, patients and orders,
why aren’t you seeing patients or attending to the student?”
Quoth the resident, “Nevermore.”

Much I marveled at this opinion, as I heard of the restrictions
meant to refresh trainees’ minds, having their brains rested,
so their learning would flow and be applied
to the betterment of patients, whose cares they must abide.
But the resident continued staring at the placid computer screen,
jotting down numbers to report and to digest, while he preened.
“But how many patients are you seeing?
Don’t you care their health to restore?”
Quoth the Resident, “Nevermore.”

“Wretch,” I said, my fumes arising, “don’t you see?
This is your training ground; the more patients that you see,
the greater be your knowledge to assuage their gentle fears?”
Quoth the Resident, “Nevermore.”

I’ve heard of birds like these, perched atop their stool,
raving on the numbers and the X-rays ’til the morn,
eager to present their patients that they hardly even knew
because their activity was splendorous, selective and reduced.
But I said, “Hey, Doctor, you whose minds must freshly be
from the increased sleep patterns and diminishing patient list,
how would you diagnose a vesicle, be it from herpes or malady,
if you’ve never seen its action, its causation and remedy
to impose your will and cure it?
Calling a consult is not the appropriate retort!”
Quoth the Resident, “Nevermore.”

At last, I retreated to the confines of my room,
blinded by the callousness of residents of the day.
‘Tis their protest for more restrictions, less numbers so they can learn
from the computer screen that presents patterns, results and the rest,
and not laying hand on the abdomen, percuss a lung, a murmur hear.

All those strange rituals from physicians of yore they scoff at and they sneer
while looking acidly at my tired countenance, and my back that is so sore
from bending down to examine, yes to listen and to explore,
while they enthusiastically look with amazement at the strangeness of it all and say, readying their presentations, “Nevermore. Nevermore. Nevermore.”

Ruben J. Nazario, MD, is a pediatric hospitalist at Inova Fairfax Hospital for Children in Falls Church, Va. Check out Dr. Nazario’s blog and others on the Today’s Hospitalist Web site at www.todayshospitalist.com.