Tuesday, August 4, 2009

Sword boat captain

In The Perfect Storm, George Clooney's character, Billy Tyne, tells Linda Greenlaw, a woman sword boat captain, what he finds special about his job:

The fog's just lifting. Throw off your bow line; throw off your stern. You head out to South Channel...the guys are busy; you're in charge. You know what? You're a goddam sword boat captain! Is there anything better in the world?

At the core of medical jurisprudence is the concept that the physician is the "captain of the ship," meaning that the ultimate responsibility for the fate of a patient rests with him or her. We may delegate tasks to other health care professionals, but when there is a bad outcome, we are the ones held liable. And this is how it should be. Yet today, in the politically correct environment of a modern hospital, we are told that we are to function as a team, unrestricted by the traditional hierarchy. Any and all members of that team can and should question the decisions of the physician, according to this new paradigm.

Last night I received a call from a hospital pharmacist regarding an order written by one of my partners earlier in the day. The patient was a gentleman with refractory heart failure which was not responding to conventional treatment. My colleague appropriately chose to initiate an infusion of a drug indicated for just such a condition. The pharmacist had called to tell me that the drug would need to be brought in from another facility, but then proceeded to share with me her opinion regarding the patient's care and our choice of treatment (which did not meet with her approval). She informed me that as a pharmacist she was qualified to do more than simply comment on drug interactions and incompatibilities.

After our conversation, I found it ironic that although I stayed at the helm as it were for the remainder of my call night, she finished her shift and left. As Linda Greenlaw wrote in her book The Hungry Ocean, never ask the crew of a sword boat if the hold is full, because "the crew always want to go home."

Swam at Nitro with Tom and Jordan, next to Lynne and Steve.

400 swim, 400 kick, 400 pull
16 x 50 @ 1:00 IM order, drill/swim by 25
3 x 200 IM @ 4:00, went 3:08, 3:04, 2:59, averaged :38-:39 for the fly
2 x 50 "lung busters" kicking underwater with fins, made it about halfway

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