Sunday, February 21, 2010

David doesn't believe in magic

As scientific, evidence-based fields go, medicine has to rank at or near the top. The best doctors make clinical decisions based on both years of experience and what the newest research has identified as the appropriate standard of care. Yet anyone who’s seen a medical TV show or spent any time on an inpatient ward has probably noticed the prominent role of superstition in what is otherwise a primarily logic-based endeavor.   

One of the more benign examples is the concept of “clouds.” For those unfamiliar, a white cloud is someone who brings good luck and light call nights along wherever he or she goes, while a black cloud puts Murphy’s Law to the test with regularity. These terms are often applied jokingly or even affectionately on the wards, yet it’s not uncommon hear them said with a completely straight face. I’ve also heard students and interns scolded for predicting easy call nights or forecasting uncomplicated patient stays based on all of the relevant admitting information.  

                                         I hope this isn't the MI cloud...                                                                  

Admittedly, a fair amount of this superstition is tongue-in-cheek inside joking. Yet I’ve been repeatedly surprised at how superstitious nurses, residents, and even attendings can be, particularly with regard to call nights and new patient admissions. As another example, during sign-out, when the daytime team gives a quick heads-up to the call team or night float about any pressing patient issues to be aware of overnight, I’ve had multiple permutations of the following exchange:

David: Ok, for Mr. X, I don’t anticipate any issues…

On-call Intern: Gah! Don’t say that! [Scrambles to knock on table]

David: …with him…wait, what?

On-call Intern: Never. Say. That. It’s bad luck.  [Knocks on wood again and prepares to sacrifice small bunny on a tiny altar made of old reflex hammers and adorned with four-leaf clovers]

David: Uh…Ok, sorry. I, uh, hope everything goes to pot and you get called all night about him…?


After a few of these encounters on multiple rotations, I’ve come to take a slightly different tact, at least with those superstitious housestaff members with whom I’ve developed a friendly rapport:

David: Light call so far? No admissions?

On-call Intern: Shhhhh! Don’t jinx it!

David: Jinx what? The fact that tonight guarantees to be a complete admissions shut-out?

On-call Intern: Dude…

David: That this call will henceforth be the standard against which all other easy calls will forever be judged?

On-call Intern: I’m going to slap you…

David: The fact that the Deities of Patient Admissions – may they smite you if they exist – are clearly too impotent to put forward a worthy challenge on your call night?

On-call Intern: Forget the bunny, I’m going to sacrifice you instead.

David: That…

On-call Intern: You do realize I evaluate you, right?

David: Ruh-roh.


Maybe this is why I’m a black cloud…




Second Shift said...

As a diagnosed black cloud, I shudder at your brazen tempting of fate!

Albinoblackbear said...

My name at RJH emerg was "Princess Crazy Cloud" because whenever I worked nights the psyche admissions would go up by about 150%.

And yes, you *never* utter the "Q" word in an ED. I had to escort an unstable pt to [Even Bigger Hospital] one night and upon arrival I said to the paramedics, "wow can you believe how quiet it is in here tonight??"

*Cue record scratch noise* Everything stopped-all the phones ringing, people talking, monitors binging, label printer printing--I narrowly escaped becoming an admission myself.

Anonymous said...

Nooooo not the Q word! I can't even bring myself to type it. I've never heard of the "cloud" thing, where I work the unlucky individual is usually a "sh$t magnet." There must be something to it though, I know I just about get sick every time I see I'm working a certain MD and RN - both great people but I swear it never fails that when the three of us work together its not a matter of *if* it will the fan but when.

Anonymous said...

Hit. Will *hit* the fan. See even thinking about working with them makes me nervous...(shaking head)

D said...

ABB: I have psych next, perhaps I can be a crazy cloud too.

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Saladman said...

I think you mean take a different tack, this term is from sailing. Tact on the other hand has nothing to do with taking one direction or another.

Please forgive me, my mother was a frustrated English teacher and my father smelled of Vitalis.

I am a shaman, and even I am not that superstitious! Are these folks completely confounded by logic?

Tony C. Saladino