Dr Tymo was incredible to work with, rounds with him was like working with a walking medical encyclopedia. He was smart but demanding. Working with Tina and Kroll had me prepared for him. Sean and Mary struggled with him in rounds. I had to make sure I hit the books before I presented my cases if I was unfamiliar with some issue my patients had. One evening as he was leaving, he told me about a patient who was coming in with suspected amniotic fluid embolus. This was a serious, high mortality problem that occurs immediately after delivery. He had been called directly by her attending, and unlike most admissions where the senior residents assessed the patient, this was a direct admission to the ICU. He ran through a list of things I needed to do for this patient because the mortality was extremely high. I took notes of his plan and anxiously awaited the patient’s arrival. 

When she rolled through the door I was all over her case. As the nurses hooked her up to all the monitors and did their primary assessment. I review her chart, 21, first pregnancy, prolonged labor, given 20 liters of IV fluids during her labor. Her fluids were run wide open because of sustained hypotension during labor. I looked at her urinary output and it was good but not good enough for the 20 liters of fluid she got in. I examined her and indeed she was short of breath and her lungs had rales, she sounded wet. I reviewed the medical literature on amniotic embolus and she didn’t fit the bill. Instead on doing what Dr Tymo wanted, I gave her the diuretic Lasix instead. I was pretty sure I had it right and checked on her frequently though out the night. By the morning, she had peed like a champ and her breathing had improved. She was smiling and a happy camper.

When I presented her case during our sit down rounds, Dr Tymo anxiously listened to hear how his suggested interventions helped. I told him I didn’t do what he suggested, I have her Lasix instead. I explained that I thought she was fluid overloaded. You would have thought I said I killed his mother, the way he carried on. He proceeded to lecture me on amniotic fluid embolus and how fatal it is and how it was important for me to follow instructions and yada, yada, yada. He went off on me. I started to feel pretty low as he lectured me in front of my cohorts, senior and nurses. But I knew I did the right thing. When he finally settled down, he asked how she was doing. I said she was fine. I prayed she hadn’t declined since I saw her before the start of rounds. When we got to her bedside, thankfully, she was sitting up, smiling and eating breakfast. Dr Tymo never acknowledged I did the right thing. In his mind I went against him and that was the worst thing in the world. He was pretty cool towards me the rest of my rotation on the “death star”, but it was okay. I did what he failed to do, make the right diagnosis. Dr Williams gave me my only compliment about my manangement of that case. She patted me on the back. That was it. I was feeling pretty good after that. But that would last too long before the next train wreck came running my way.