Off-Service

Today is the last day of yet another intensive care unit rotation, and I am writing my “off-service” notes. The notes describe how patients presented on admission and detail their hospital stay. There are 6 patients, 6 off-service notes, but 1 stands out—“Mr. Jones,” an intensive care patient that I “inherited” from the last intern. Every time I am in the intensive care unit, I care for at least one patient like him and I always leave his note until the end, dreading it because of what it is going to say. It will show that I am a failure and a criminal.

Mr. Jones came with an off-service note from an intern who preceded me, and his note detailed an extensive hospital course with innumerable diagnostic tests, surgeries, and therapies. I remember the first time I read a note like this. I was a fourth-year medical student, starting my medicine subinternship, eager and determined to fight epic battles with all the diseases of my patients in …