There’s nothing like a sea of white coats marching down the halls on rounds at 6:30 am. As I walk with the team I catch the scent of loose bowels and sterility combined with the morning breakfast trays – I know I’m in for a bit of fun.
All 8 of us crowd into the patient’s room, almost always waking them from sleep. “How was your night?” The student responsible for following the patient responds if the patient takes too long to answer the question. “There were no acute events overnight. The chest x-ray came back late yesterday evening and was clear. His white count has dropped down from 12000 three days ago to 8500 this morning.”
Once the plan and disposition for the patient has been discussed and the student has been thoroughly pimped on anything and everything possibly related to the patient, the entourage exits the patient’s room in single file to repeat the process all over again. I am reminded of kindergarten, lining up to go take a piss as a class. We were all equals back then with the exception of one.
If you’ve ever witnessed one of these white trains while on the wards, you’ve just seen the hierarchy in motion. Attendings are always at the front, and you can differentiate the chief resident from a student just by watching this little tidbit of medical school mystery. It never fails, so take notes.
While exiting a patient’s room, everyone cautiously steps to the side to let the train take form early for the next destination. God forbid messing up the chain. If a student or lower-level resident misjudges and takes a place towards the front, he is quickly corrected as the senior steps in to take over his hard-earned spot.
Most probably consider it disrespectful to walk in front of your superior while on rounds. This has been subconciously ingrained into your mind during your short career on the wards. If you consistently do this, you might be looked down upon and something could possibly even show up in your evaluation regarding your lack of “professionalism.” Tread lightly – you’re always walking on thin ice. Get someone on your back and you’ll be ridden like a cheap whore for the entire stent of your stay.
These stern rules are passed down to each generation in the hierarchy, and they are enforced at an increasingly exponential level at each stage. The attending was once at the rear of the entourage, and has anxiously watched as he slowly crawled towards the top spot. He enjoys the stares from nurses, but what really makes him feel like the cock of the roost are the gazes from patients and visitors.
By walking in front, you have just bypassed the entire system. Cheated it, if you will. This effectively allows any onlooker to remove his or her focus from the attending and place that focus on you. The highlight of the attending’s day has been spoiled.
Wondering what all the fuss is about? Just wait until you’ve participated in this train hundreds of times and you’re working your 10th straight day on 3 hours of sleep.