Pollyanna.

Her: "Do you think we should do any more testing?"
Me: "I think we should check another round of cardiac enzymes, don't you?"
Her: "I don't know, Dr. M. The timing aligns with the crack use."
Me: "That's true."

*silence*

Me: "Cocaine accelerates coronary heart disease. So, like, even if you use, it adds risk both short term and long term."
Her: "I get it. I guess I'm just trying to think through what we would do next, you know? If the cardiac enzymes are positive. Would we suggest cardiology come do a cardiac catheterization?"
Me: "If they are suggestive of an acute coronary syndrome? Yes."
Her: "Hmmmm. But let's think this through. So then we do the cath and it calls for an intervention. And then the intervention calls for the patient to take anti-platelet medicines that must be taken."
Me: "And that if they don't take them they'd be worse off."
Her: "Exactly. So I am torn. This isn't because I don't want to advocate for the patient. It's actually because I do."

*silence*

Her: "So what do you think?"
Me: "The same thing. Check them."
Her: "Really?"
Me: "Yeah."
Her: "And if the cardiac enzymes are positive?"
Me: "Consult Cardiology."
Her: "For a cath? And intervention?"
Me: "Yeah."
Her: "You wouldn't be scared of doing harm?"
Me: "I'm always scared of doing harm."

*silence*

Me: "Listen. I should tell you. I'm a total Pollyanna. . an eternal optimist--often to fault. So I want you to know that I truly get what you are saying. But I always have this little idea in my head that I can encourage the patient to quit. Like, if your heart depends upon it? And I believe right along with you that this isn't your lot in life and that you can recover? Yeah. I tell myself that this might be the day. The discussion that turned the ship around."

*silence*

Me: "But I get it."
Her: "I get what you're saying, too."
Me: "You make great points."
Her: "Let's check one more set. And if they are abnormal, we will cross that bridge when we get to it."
Me: "I like that plan."

*silence*

Her: "Hey Dr. M? What's a Pollyanna?"
Me: "You don't know what a Pollyanna is?"
Her: "I'm a millenial."
Me: "Then Google it."
Her: *smile*
Me: *smiles back*

Let's be clear: My resident is sensitive and empathic. And this discussion is as old as crack cocaine itself when it comes to ethical dilemmas at Grady. But regardless of that and all that I see, I can't shake my optimism. Some piece of me always believes that this might be the day.

Yeah.

I love this job.
****

#amazinggrady #eternaloptimist #igetburntalot #butsometimespeoplewin #blindspot #rooterfortheunderdog #alwaysalwaysalways #thismightbetheday