On Saturday I received an email from the Office of Personnel Management in Washington, with the subject line: “What did you do last week?” OPM runs the civil service, and as a critical care physician and medical director of intensive care units in federal, local and rural hospitals, I am in part a government employee.
I wondered how to answer the email. Was I supposed to highlight what actually mattered — the human lives in my care — or list what OPM might deem important, in a bureaucratic exercise? Without context, the request felt mostly like a demand, not a legitimate inquiry. The lack of respect was palpable. A colleague had to point me to news articles about the email — a new wrinkle in the Trump administration’s chaotic approach to government efficiency — before I could even determine whether it was a hoax or a phishing scam.
If Washington truly seeks to understand the work I do, or to foster organizational change, common sense tells you there are better ways. Effective leadership requires clear communication, thoughtful analysis and — above all — trust. This email had none of that.
But since they asked, here’s what I did last week:
- I cared for Darrell, a 70-year-old veteran with a kidney transplant and sepsis. He had a painful, life-threatening fluid collection in his chest that I drained to relieve the pressure.
- I sat for hours with the family of an 85-year-old veteran with Parkinson’s, heart failure and a recurrent MRSA infection. Together, we navigated the complex, often politicized landscape of end-of-life care.
- I diagnosed and assessed lung disease severity for more than 50 veteran patients.
- I audited 20 patient charts for coding accuracy and strategized about how to improve compliance.
- I supervised, coached and trained almost 10 medical trainees daily in the care of critically ill patients.
- I worked with pharmacy and nursing supervisors to refine a novel protocol for treating alcohol withdrawal, a life-threatening condition.
- I coordinated with pharmacists, nurses and cardiothoracic surgeons on safe, cost-effective dosing strategies for amiodarone, a heart rhythm medication.
- I arranged the complex transfer to another hospital of a veteran with liver failure and an acute joint infection who required specialized surgery, and I tried to assuage his anxiety, including whether insurance would cover him when he got there.
- I answered detailed questions about blood transfusions for an 84-year-old man with metastatic bone cancer whose transfusions had exacerbated his heart failure in a suburban hospital.
- I intubated an 82-year-old man and put him on a ventilator after he returned from Europe with a devastating respiratory virus. Before sedation, he said goodbye to his family, not knowing whether he would wake up again.
- I managed physician schedules in a rural ICU plagued by perpetual funding shortfalls.
- I treated a 62-year-old former nurse suffering from severe depression and alcohol-use disorder who had attempted suicide by overdosing on multiple antidepressant medications.
- I wheeled an ICU nurse to the emergency department when she fell ill mid-shift, burning with a 103.5-degree fever.
- I strategized about applying for potential philanthropic support for physician burnout research given National Institutes of Health funding cuts.
- I cared for an 80-year-old man with multiple brain hemorrhages and an obstructed bowel, stabilizing his blood pressure with infusions.
- I comforted the family of a 76-year-old woman whose uncontrolled hypertension had caused a catastrophic brain hemorrhage. She was in a near-coma. After hours of discussion, they elected hospice, and she passed away peacefully that evening.
I could go on.
Here’s my question: What did the Office of Personnel Management do last week? Did it help me take care of these patients, or did it burden a system already buckling under its own weight?
Before OPM answers, I’d suggest it recognize that the work my colleagues and I do is accurately measured not on a spreadsheet but in the lives we save, the families we guide through loss and the next generation of physicians we train to do the same.
That’s what I did last week. What will OPM do next?
Venktesh Ramnath is a pulmonologist and critical care physician in Southern California. He is an associate professor at UC San Diego Health, medical director of the San Diego Veterans Affairs intensive care unit and medical director of El Centro Regional Medical Center intensive care unit.
