Rural Doctoring

Dr. Santell's Rounds: The Long Goodbye

I've been through a bumpy ride professionally the past several months, and last week my colleague and I were on the verge of giving notice and looking for greener pastures, but a certain amount of ingenuity and iron nerve (mine) and a large amount of diplomacy (his) managed to save the situation, at least temporarily. I would say "phew" except I don't really feel relieved. Practicing medicine is difficult, but making a living, holding down a job, keeping one's foot firmly planted in the realm of acceptable working conditions is even more so.

Dr. Santell's Rounds: The Ticket

Every doctor sees patients with diseases related to substance abuse, both legal and illegal. The other day I looked at my hospitalist census and realized 65% of the patients I was seeing had illnesses either caused by or worsened by alcohol and tobacco abuse.

Dr. Santell's Rounds: Still My Conscience After All These Years

This isn't a story about Dr. Santell, but it illustrates why the memory of Dr. Santell is so important to me, and why sometimes I pretend he's still alive and only a phone call away. I know this is nothing more than childlike fantasy, but it gets me through some long days and--as this story shows--keeps me honest on the job.

Dr. Santell's Rounds: Do the Right Thing

One of Dr. Santell's pet peeves was how residents wrote orders for intravenous (IV) fluids.  I used to spend an inordinate amount of time trying to figure out how to order fluids on a new admission without doing something stupid--giving dextrose-containing fluids to a poorly controlled diabetic, for example.  

I'll admit a lot of this dithering was no more than an attempt to read the old man's mind, because he was always very specific about his fluid orders.  For example, he hated it when one of us ordered the default 1/2NS + KCL 20meq at 125cc/hr on a CHF patient receiving Lasix, for example.  One of the standard rites of passage at our residency was to have Dr. Santell say to each of us:  "You may have heard me say this before, but I don't like giving fluids and Lasix in the same patient."    Those of us who'd heard this speech before snorted quietly in the background, but the hapless new intern who was presenting the case turned beet red, although he wasn't really in trouble.  You were only in trouble with Santell if you made the same mistake twice.

Dr. Santell's Rounds: A Few Pages Every Day

When we were interns we had to get used to the seemingly constant presence of Dr. Santell at the hospital.  Although he usually left work in the late afternoon, his pervasiveness began early in the morning.  He routinely showed up at 5:30 am, although you never saw him on the floor before 6:00 am.  He understood the importance of starting the day early but he didn't like the idea of patients being woken up before 6:00 am.  Even on the busiest inpatient service, he wouldn't allow us to begin rounds before this hour.

Dr. Santell's Rounds: Don't Be Common

During an intern year rotation in Surgery I saw a patient with a large abdominal wall abscess. My progress note looked something like this:

Dr. Santell's Rounds #1: Make Time For Breakfast

The first time I met Dr. Santell I was a fourth-year medical student arriving for my first day of a rural family practice elective. I'd been told to show up at 7:30am in the main conference room to attend the Morning Report. When I arrived, the room was empty, so I took a moment to decide where to sit. There were about ten 6-foot long rectangular tables lined up in rows of two, each with three seats. I didn't want to sit in the front row like a geek, but I also didn't want to creep around in the back and look like a slacker on my first day, so I sat in the first chair in the second row, closest to the door.

Morning Report was an institution at this hospital, where I went on to do my residency. Because the residents ran all the services in the hospital--Medicine, Peds, OB, ICU, Surgery--the different services did not meet individually. Instead, the daytime residents finished pre-rounding at 7:30 to meet with the Night Float or post-call residents at the Morning Report. The conference room was next door to the cafeteria, so everyone picked up breakfast and ate it while the night team presented cases.

Dr. Santell's Rounds: An Introduction

Fat Doctor recently shared her grief over the loss of a colleague on her Twitter feed. My sympathy for her loss motivated me to begin a project I have been planning to share on this blog even before I launched it: Dr. Santell's Rounds.