Doctoring by number

Short White Coat is a blog about learning to be a doctor. Posts appear here as part of White Coat Notes. Ishani Ganguli is a third-year Harvard medical student. E-mail her at shortwhitecoat@gmail.com.

My first job of the day is gathering The Numbers: heart rate, temperature, blood levels of sodium and calcium…Every morning, well before 6 a.m. surgery rounds, I spread out the records of each patient I’m following onto the nurse’s station counter and pen these values into the slots and grids I’ve carefully ordered on a notecard.

The order is key, the first thing to master — when I later recite the numbers to the team outside my patient’s room, breathless from our group-sprint down eight flights of stairs. Meaning will (hopefully) spring out of this predictable arrangement.

It’s not the most glamorous part of the surgery rotation — the suturing, stapling, and appendix removal (with supervision) make for better stories, to be sure. But analyzing the numbers lets the team decide if our patient’s bleeding risk is low enough to send him to the O.R., how much fluid loss needs to be compensated post-op with an IV drip, and when he can go home.

These are the same figures that we medical students dissected with gusto when they were attached to faceless tutorial cases last year, and I remind myself to approach these with the same rote analysis.

My task is to flag the numbers that are “abnormally high” or “low” — on computerized records, such values are automatically branded in scarlet — while applying healthy skepticism to these designations of normal. (For one thing, the “normal” reference range is designed to pick up only the middle 95 percent of the healthy people sampled, so falling outside this range is not necessarily meaningful.)

I want to know how these numbers compare to the individual’s baseline values (maybe she’s always had low blood pressure) and then, to others in her demographic. I must also think about the context of the numbers around each figure (a “normal” amount of new blood cells may be inappropriately low when there are too few blood cells to begin with, for example).

Then I remember that at the end of the day (or minutes before 6 am, as it were), the most important indicator of the patient’s well being is found inside the hospital room: the rosiest of numbers pale next to a clearly distressed patient, and the direst values can be stripped of their power next to a smiling one.

And so, with a squirt of Purell and a knock on the door, I go in and see the person the numbers attempt to represent. It is, after all, the reason I’m there.