12/28(木)
◆今日の気持ち
(外科 3ヶ月目)
・今日もまだ体調がとても悪い…
・今日で仕事終わり。研修医は年末年始はうちでは仕事ないのがさびしくもあったが、せっかくなので病院はなれていろいろ勉強してこよう
・今、歯車をあわせることができていないところを考え込んでみた。…仙人的な自分は日常会話に興味がなく話の土台をつくれてないことに加え、ついつい自分が間違えているという前提で話を聞きその感情が顔に出るからリズムが必要なやり取りができない。まあ、それは生来の性質なので手の出しようがない仕方がないことだとする。問題は、無意味・無価値に日々をすごしている、という感覚。何故だ?
…一番やりがいのある、現在、に手をだせないから、なのかな。いつも、診断がつき治療法も決まった患者がいつの間にやら入院している。freshな状態での問診・診察はできないし、治療もお客さんとしての参加だし、あとで隠れてた病気を見つけたところで嫌な顔されることもあった。でもまあ、そんなものだときちんと受け止めねば。何故そんなものなのか?
…過去、後ろを追っかける。上の医師のやり方を身につける。その次に、未来、先回りして準備ができるようになる。やり方をコピーできるようになったことを確かめる。そうして過去・未来をおさえてからやっと、現在、治療に手を出せるようになる・出させてもらえるようになる。それは正しい順序なわけで。治療に集中して参加できないしfreshでもないし手にrealな所見もとれないような状況では患者の状況を記憶はできないしそんな理不尽の中記憶力を使う気もない、と腐ってみていたが、無意味な腐りはとっととやめる。カルテに書いているし、と、意義が見えなくて外科に来て書くのをやめていたサマリーを、少し脱力しつつもまた書くようにしてみようか。
・忙しい病院の研修医って、現在、に振り回され勉強は耳学問以上はできなくなるもの、なのだろうな。
・昨日言われた、「何度も言っているだろう」と怒られた言葉が胸に引っかかっていることに気づく。カルテもどうとでも読める状況の中、一度も状況聞いていなくて考え込んでいた自分が馬鹿、ということで。手術所見としての大きさとか可動域とかきかれても時々手を出すのが精一杯なときに聞かないのが悪い、が、それが上下関係というもの。
・そういえば、考え込むタイミングと、聞くべきタイミングのバランスが取れていない。
・でも、下の人間に聞けば情報はすべて聞きだせる、というカルテや他者の記録を読むつもりがない手抜きの姿勢は医師のあり方として間違えている。気がする…。そういった理不尽に応えることは、研修医としてすべきではない。今後は逆らっていこう。
・でもまあ、世の中やひとの生き死になんて理不尽なものだし、身を任せるときは任せるべきか…
・ただ時間を一緒にする、ということは大切とはきくけれど、仙人的な自分には無理だし、ぼちぼちとぼちぼちいこう
●目指す医師像
総合内科医 問診を極めたい
西洋医学的には1〜2剤のみつかう医師
症状には漢方を使用する医師
●今日の新患・診断
・突然死(到着時心停止 既往:鬱 前日下痢 くも膜下出血??)
●今日の病院滞在時間
8時半〜18時半
●今日行ったこと・見たこと・知ったこと
・開腹胆嚢摘出
●今日うまくいかなかったこと・失敗
・昨日、摘出した胆嚢に触り損ねた…。体調悪かったからしかたないけれど…。
●明日の予定
・漢方合宿
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