The Cookie

“Kyle, have you met Dr. Z? He’s the Chief Clinical Officer of the health system and also an Emergency Medicine doc. Dr. Z, this guy’s applying for the ER here! You’ll like him!”

“Oh yeah? Nice to meet ya. Hey, do a good job today, and I’ll give you a cookie.”

Entering my first multi-disciplinary rounds (MDR) of the month on my second inpatient medicine rotation of residency suddenly became a lot more stressful. Not only was I expected to lead the discussion of all 18 of our team’s patients (of whom only 7 I was actually taking care of personally), but the CCO of the health system, the second-in-command doctor and top dog of the non-physician clinical policies and practices, was there, too. If I bombed this meeting, it would surely mean the end of my chances to get into the Emergency Department here.

Dr. Z gestured toward a box full of individually-wrapped Chick-fil-a cookies sitting in the center of the table. Wrappers were unceremoniously scattered about the table near different team members, meaning that I clearly was not the intended recipient of one of them.

But a starving resident will never turn down free treats.

I took my seat next to Dr. Z, looked about at the gathered team, and dove straight in.

“Bed 18 is a 72-year-old male being evaluated for CHF exacerbation. We’re awaiting an echocardiogram and improvement in his fluid status, anticipate two more days.”

Multi-disciplinary rounds are a time when the entire care team- doctor, nurses, charge nurse, social worker, case management, and hospital administration- get together to discuss each patient, their care needs, goals, and what needs to happen to facilitate discharge. On the acute inpatient medicine floor, these meetings happen daily. In acute inpatient rehab, where I was first exposed to MDRs as a medical student, it was twice a week; though, patients typically stayed longer and had less turnover in rehab than on the floor.

Although the physician leads MDRs, they really aren’t for us. We have our tests, results, procedures, plans. We know our medicine. Occasionally nursing will bring up a concern they hadn’t yet voiced that changes our plans. But MDRs are for the rest of the team, especially for the social workers, case management, charge nurses, and other managerial members of the care team. They don’t care about results, what we’re looking for, etc. They care about how long the patient has been here, how much longer they need to stay, and where they will go when it’s time to leave.

“Bed 22 is a 54-year-old female with endocarditis. She needs a PICC line and coordination with infectious disease for her antibiotic regimen upon discharge.”

Some patients I know really well (my own), others I barely squeak out a passable one-liner. There were some good teaching moments from Dr. Z, and opportunities to voice our concerns about other things that needed to get to the administration’s attention.

“Bed 31 is a pleasant 92-year-old female here with pneumonia. She developed kidney injury yesterday, so she won’t be able to go home for a couple more days.”

With each patient discussed, the possibility of getting a cookie got that much closer. My mouth began to salivate. Was it pride, wanting to impress the CCO? Was it hunger, wanting a sweet treat for the sake of eating a cookie? Did I really just want to perform well for the accolades of others rather than for the benefit of my patients?

No, I want to do the best I can for my patients. That’s why I’m here.

That is why I took notes during team rounds on my co-resident’s patients. That’s why I gave up time I could’ve been typing notes to listen to my colleague present their patient.

Finally, the last patient was discussed, and everyone started to leave. It was time to get back to the work of caring for our patients.

And in my hand, was a cookie.