On Saturday, an email from the Office of Personnel Management (OPM) in Washington popped into my inbox. The subject line read: “What did you do last week?” Now, since OPM oversees the civil service and my roles as a critical care physician and medical director at various hospitals partially classify me as a government worker, this question held a certain gravity.
I found myself pondering how best to respond. Should I focus on what truly matters—the human lives I tend—or should I mention what OPM might consider noteworthy in their bureaucratic framework? Without proper context, the email seemed more like a directive than a genuine inquiry. The tone lacked respect. I had to glean from news articles, pointed out by a colleague, that this email was just another peculiar aspect of the Trump administration’s tumultuous approach to government reform; it wasn’t a phishing attempt or a prank.
If Washington genuinely aims to grasp the essence of my work or drive organizational change, there are more sensible approaches. Any effective leadership hinges on transparent communication, careful consideration, and, most importantly, trust. Unfortunately, that email missed the mark on all counts.
But since the question was posed, here’s a glimpse into my last week:
I cared for Darrell, a veteran in his seventies with a kidney transplant and sepsis. He had a painful and life-threatening fluid build-up in his chest that I drained to ease the pressure. I spent countless hours with the family of another elderly veteran grappling with Parkinson’s, heart failure, and a recurring MRSA infection, guiding them through the complicated and often politicized realm of end-of-life care. For over 50 veteran patients, I diagnosed and measured the severity of their lung diseases. Additionally, I reviewed 20 patient charts for coding accuracy and strategized improvements for compliance.
Daily, I supervised, coached, and trained nearly 10 medical trainees in caring for critically ill patients. Collaborating with pharmacy and nursing supervisors, I worked on developing a novel protocol for dealing with alcohol withdrawal—a condition with potentially fatal outcomes. Together with pharmacists, nurses, and cardiothoracic surgeons, I coordinated safe and cost-effective dosing strategies for amiodarone, a heart rhythm medication.
I facilitated a complex hospital transfer for a veteran suffering from liver failure and an acute joint infection, requiring specialized surgery, while also trying to soothe concerns about insurance coverage. I answered intricate questions about blood transfusions for an 84-year-old man with metastatic bone cancer, whose transfusions had worsened his heart failure. I intubated and put an 82-year-old man on a ventilator after he returned from Europe with a severe respiratory virus, watching as he said goodbye to his family, unsure if he would awaken.
Additionally, I managed physician schedules in a rural ICU consistently strained by funding shortages. I treated a 62-year-old former nurse battling severe depression and alcohol-use disorder, following a suicide attempt via overdose. When an ICU nurse fell ill mid-shift, burning with a 103.5-degree fever, I personally wheeled her to the emergency department. I also strategized applying for philanthropic support for physician burnout research, given recent NIH funding cuts.
I cared for an 80-year-old man enduring multiple brain hemorrhages and a blocked bowel, working to stabilize his blood pressure with infusions. I comforted the family of a 76-year-old woman whose uncontrolled hypertension led to a catastrophic brain hemorrhage, leaving her nearly comatose. After hours of discussion, they chose hospice, and she passed peacefully that evening.
And I could certainly list more.
So, here’s my question: What did the Office of Personnel Management accomplish last week? Did it aid me in caring for these patients, or did it further strain a system already overwhelmed by its constraints?
Before OPM drafts its response, I would urge it to appreciate that the true measure of our work is not in spreadsheets but in the lives we save, the families we help navigate their losses, and the new wave of physicians we train to continue this vital work.
That’s a snapshot of my week. What actions will OPM take next?
Venktesh Ramnath, a pulmonologist and critical care physician in Southern California, is an associate professor at UC San Diego Health and serves as medical director of the San Diego Veterans Affairs intensive care unit and the El Centro Regional Medical Center intensive care unit.
