I entertained the idea of quitting medicine after my first night on call during my internship year. On that night, I felt petrified assigned to the Neonatal Intensive Care Unit (NICU). Joe, the third-year resident camped out in his call room, gave clear instructions. He should only be disturbed if an infant deteriorated during the night. In the competitive culture of the residency program where I trained, the senior doctors, known as the “attendings,” supervised the interns and residents from the comfort of their homes. The unwritten rule stopped residents from consulting them in the middle of the night.
While I was hunched over a micro-preemie completing a procedure, a nurse asked if I wanted to give antacid to an infant who had acidic undigested formula in his stomach. Clueless, I breached protocol and interrupted Joe’s football game. Calmly, he approved of the plan to give the antacid. I researched the dose and wrote the order in the infant’s medical chart. The nurse informed me in the wee hours of the morning that the infant with the acid issue improved.
The next day as morning rounds began, I reflected on how all the infants and I had survived the night. Because of exhaustion, I barely noticed the blinking lights of the breathing machines and the beeping sounds of the IV poles. Before me in one large room stood twelve tiny babies in their respective incubators with their nurses hustling around them, inserting IVs, changing diapers, and dispensing medications. I began my discussion of each infant’s events during the night to the senior physician, the two other residents, and several medical students. The attending physician, Dr. T, asked questions, and I answered moving from one crib to the next. When we reached the infant I’d written the order for the antacid, Dr. T stared at the crib. Suddenly, without warning, he grabbed the bottle of antacid sitting prominently on the shelf just above the infant’s bed. While hurling the bottle towards me, he yelled an expletive and followed with the question that haunted me for many months, “What are you doing, trying to kill this infant?” He followed the outburst with a quote from a research journal about the potentially fatal adverse effects of using antacids in premature infants. Luckily, my years as an athlete helped me dodge the bottle which settled near my feet. The room seemed to disappear. The infant’s incubator crib appeared to leap into my vision inches from my face. I felt hot all-over and my palms felt wet. No one said anything to diffuse the situation. Not one nurse revealed that ordering antacid had been a common practice. Dr. Joe, the supporting resident, had already left the NICU. Nothing could have insulated me from the humiliation. I quickly scribbled an order in the patient’s chart to discontinue the antacid and jotted a note on my clipboard to find the research article to read later that day.
As the morning rounds continued, the bottle of antacid rested in the middle of the floor. Did anyone, fellow intern or senior resident, or one of the nurses have the courage to support me that morning? Did anyone else see the hurled bottle as an assault? Maybe not. After rounds, in the privacy of the bathroom, along with my tears and simmering anger, I reflected on the dynamics that would allow one person to treat a team member with such unfiltered anger and disrespect. What did the Attending physician possess that the rest of the team lacked? He could claim seniority. He possessed seniority in a rigidly hierarchical system. He occupied a position of privilege in relation to everyone else. In the privacy of the bathroom stall, I identified a future superpower. I promised myself that when I had the responsibility of being the senior physician in a teaching hospital, I would never shame an intern or a resident on rounds. I’d always use my superpower of seniority for good.
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