Apologies to the Fat Man and the Velominati:
We are the keepers of the house of medicine. Others have fallen by the wayside, but we are the salaried employees with no skin in the game, slaves to the shift schedule, acolytes of the Suk school, Sisyphean laborers who take care of anyone, for anything, at anytime. These are the Rules of the Shift:
Rule 1: Obey the Rules.
Rule 2: Lead by example.
It is forbidden for one familiar with the Rules to knowingly assist another in breaking them.
Rule 3: It’s about the person.
That’s the patient, the colleague, the team or family member. It’s not about your vaunted principles or your hospital’s policies. Anyone who says otherwise is a quacksalver.
Rule 4: It’s worth it. If you’re strong enough. Get strong.
Rule 5: The Night Shift Rule.
“It’s like fighting with a gorilla. You don’t stop when you get tired. You stop when the gorilla gets tired.” – Greg Henderson
Corollary to Rule 5: Bring treats.
Rule 6: If you work Monday nights it means you are a badass. Period.
Rule 7: Don’t be a jackass.
But if you must be a jackass, at least be a funny and non-cruel jackass. Remember, we are all brothers and sisters on the shift.
Rule 8: Altered mental status in the elderly is sepsis until proven otherwise.
Rule 9: There is no earthly human problem that cannot be cured with enough benzo.
Rule 10: If you don’t check a temperature, you can’t find a fever.
Rule 11: Coffee is your friend. Real sugar > fake sugar. Yes, it’s good for patient care if you have a cuppa.
Rule 12: Confidence increases with time and experience.
This pattern continues until it falls sharply and suddenly. Accept this. Keep going.
Rule 13: The delivery of good medical care is to do as much nothing as possible.
Rule 14: Life is short. Don’t drink piss beer.
Rule 15: The volume of the sounds of vomiting is inversely proportional to the medical acuity of the vomiting.
Rule 16: Diagnoses come in groups of 3. Seen 2 weird things? Look again.
Rule 17: Just when you think you shouldn’t push any harder, push a little harder.
Also known as Surgical Procedure Rule #4.
Rule 18: Pronounce it correctly. You’re a professional for @#$! sake.
Rule 19: Do No Harm is a crock. Hippocrates was wrong. Do More Good, Less Harm.
Rule 20: When the patient and the test disagree, the patient is always right.
Corollary to Rule 20: Testing low risk patients increases false positives. Always.
Rule 21: The ER gods are kind in that they always teach.
Unfortunately we are not always ready for the lesson.
