Reviews

Imaginary conversations

We did not think much of most of our chiefs, our attending physicians at the hospital. We thought they were boring, irritating, old. "Would you like to end up like him?" asked one of my fellow residents one day, as we trudged behind the old man on ward rounds that seemed interminable on hot afternoons, when the beach offered a much more attractive alternative. "Most certainly not," I replied, with absolutely no doubt in my mind.

Sometimes we would change the treatments they ordered. We knew better. We would even hide patients from them on rounds, claiming that they were down having x rays, or drawing the curtains around their beds and claiming that they were indelicately indisposed. We also made up stories about our chiefs. Not real ones, but imaginary stories about made up situations that would illustrate some trait or characteristic of their personality or conduct.

There was the academic chief, very learned, always ready to quote a couple of references, but somehow always leaving you without a definite answer to what you wanted to know. "Is it true that when it rains there is a lot of water coming down from the sky?" "Well," he would answer in this imaginary conversation, "there is actually very little data on this subject. There is an old paper in the French literature, but small numbers, poorly documented, largely anecdotal."

More practical but obsessive to the extreme was another chief, a man of great achievements. "We saved this man's life as we picked him up from the sidewalk, sir. He had jumped from a five storey buildingwe stopped the bleeding, restored his airway, treated his pneumothorax, his ruptured viscera, his haemoperitoneum, his sepsis, his coagulopathy, his acute renal failure, his pulmonary oedema, his compartmental syndrome. He is now recovering, is afebrile, and off the respirator and off dialysis, but he is still not eating well, sir."

The reply in this particular imaginary conversation might have been: "What do you mean he is not eating? Did you speak to the patient to ask him what he would like to eat? Did you consider liquid supplements, butter balls, syrup? You had better consult the dietitian right away."

There are other stories, many that we do not know and will never know. For now the students and residents make them up about us.

George Dunea, attending physician. 

Cook County Hospital, Chicago, USA