Nephrology

I'm not sure why this is, but all the nephrologists I've met seem to have this attitude that they are SO FREEKIN SMART that they must share it with everyone. My current attending is a nephrologist, and all of our pimp questions have to do with the kidney. "What is the pathognomonic kidney lesion in scleroderma? What is Fanconi syndrome, and what cancer is it associated with? What is the kidney dysfunction in sickle cell anemia?"

My attending is consistently late. It's a good day if he's only an hour late. Just to keep us on our toes, he will show up on time about once a week. Last week on call, we were supposed to round at 5 pm; we didn't round until 10 pm. The next morning, post-call, he didn't show up at all, so we checked out to the float and left. Apparently, he came some time later and saw patients on his own (which was good, because we had several patients who were waiting to be staffed so that they could go home).

I know a resident's time is not worth much. If you work their salary out by hour, it comes out to somewhere around minimum wage; an attending, even on salary, makes over two times as much. I guess some economical principle might make it okay for an attending to waste a resident's time, because their time is worth less. My argument, however, is that since two interns and one resident all had their time wasted, the wasted money is roughly equivalent. I would further argue that I am PAYING to have my time wasted. I am paying (and the government is paying, through my loans) to wait for hours while my attending goes to movies (another resident saw him one night). Add in the SHEER RUDENESS of continuously running hours late every day, and perhaps one could understand my frustration.

Yesterday, on call, we were initially supposed to round on our old and new patients at 4 pm. Around 4:30, we were hanging out in an empty room studying, and our intern came in to tell us we were now going to round at 9 pm. At 11 pm, when the attending HAD STILL NOT SHOWN UP, I figured to hell with this, I'm hungry, I'm going to go get some fast food. My interns went to bed, we hadn't seen our upper-level resident in hours, and I said screw it. I went and picked up my keys and began the trek to the parking garage to my car.

In the hallway to the parking garage, I saw my attending walking towards me.

He saw my car keys in my hand and asked if I was going home. I said "No, I was going to go put some stuff in my car, but I guess I'm not now." I pulled a 180, peeled off at a closer elevator, and started frantically calling people. "Quick, he's here, get to the conference room!" One of the students had been keeping watch on the conference room, so she zoomed out to start the text-paging while I raced up to the room, still calling people. We text-paged the interns out of their call-room, the upper-level out of wherever the hell he was, the student from the girls' call-room, and the other student who went to sleep in the medical school building on a couch. People started showing up after a few minutes, to find that our attending brought us a cheesecake. Not in any kind of apology for being late, because I don't think he really knew he was late, but "for the hard-working team." Awww.

After presenting our new patients to him last night, he looked down at his list, looked up at us, and said "Why are all our patients so boring? We only get 1 or 2 good, interesting admissions a night! This is so boring!"

Maybe that's why people go into specialties, to see the "interesting", zebra-type cases. No one wants to treat diabetes, or hypertension, or obesity, because those are commonplace and "boring". People go into rheumatology to see the bizarre vasculitides; they go into nephrology to learn the ins and outs of acid-base disorders (and he thinks diabetes is boring??). But if you're in nephrology, and you're going to take internal medicine call, then you have to be prepared to see the bread and butter of internal medicine. If you are so intelligent that these diseases bore you to tears, then maybe you should go back to the dialysis unit!

It's a good thing I usually like my attending, when he's actually there with us.