What Residency Looks Like LXXXVI: On Red Team, we are positive

Over the course of one month, Red Team took care of 102 patients: 64 women and 38 men. They ranged in age from 20 to 95 years old, with an average of 63 years old. While most were admitted for 2-3 days, their length of stay ranged from less than 1 day to 52 days, with a few long admissions pulling the average up to 6 days. There were three codes and two deaths. One patient signed himself out against medical advice. We transferred 2 patients to Family Medicine, 2 to Cardiology, and 1 to Cardiothoracic Surgery.

We learned about such rare diagnoses as Sturge-Weber Syndrome, Castleman Disease, and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). We also took care of patients with common medical conditions: atrial fibrillation, congestive heart failure, pulmonary embolism, and infected foot ulcers, and we practiced managing pain, blood pressure, and blood glucoses in the hospital.

One patient refused dialysis, but his kidney function improved anyway; another patient's kidneys got worse and had to be started on dialysis. Most of the people admitted with chest pain concerning for heart disease were discharged with other diagnosis, but two of them went to the cath lab to get stents for on-going myocardial infarctions, and in the process they reminded us that women's heart attacks can present differently than men. We diagnosed four people with cancer, one of them for the third time.

The team shared lighter moments, such as the patient who asked us to autograph her facecard.* The workroom was often filled with laughter, sometimes with music, and once we smuggled a chocolate candy bar on rounds. Some patients had interesting allergies listed in their electronic medical records: tomatoes (reaction: worsens arthritis^), oral diuretics (but somehow not IV diuretics), and cocaine (!). One woman took a record number of herbal supplements at home (9).

There were difficult moments: The patient who made sexist comments about one of the medical students in the middle of morning rounds. The woman who didn't like the intern who wears a headscarf and speaks with an accent. The patient who insisted against all evidence that the interns had asked the nurses to dilute her pain medication. The family member who complimented "the colored boy," a young African-American patient care technician who helped feed her husband when he couldn't do it himself.

There were moving moments: One man had a peaceful death in the same wing of the hospital in which he had been born. One of our "difficult patients" thanked me for pulling up a chair most afternoons of her month-long hospital stay: "No one else comes to visit me." Another "difficult patient" cried when I told her that I was rotating to a different hospital. We became close with the staff on the floor, too, including one of the nurses, who--having been publicly berated by a patient's family member--tearfully confessed to me, "I feel like I'm a member of your team."

Medicine is a team sport: patients, doctors, families, nurses, consultants, food service, environmental service, operators, therapists, care managers, social workers, secretaries, and ED staff. We don't always agree on the diagnosis or the plan, and sometimes no matter how hard we try, we cannot not fix a patient's problem, but the important part is that we are in it together against pathology and red tape, not each other. This weird and wonderful calling of caring for sick people, often at their worst moments, can sometimes bring out the best in us and others. On Red Team, we are positive.

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*A facecard is just what it sounds like: a piece of card stock with the names and faces of the medical team taking care of the patient.
^This medical myth was promulgated by a 1993 theoretical paper but has never been substantiated by high-quality evidence.