In the course of my first week as a doctor, there are three phrases I have said more often than in the rest of my life combined:
(1) “Have you passed any gas yet?”
(2) “Nurse, could you save that poop so that I can come up and take a look at it?”
(3) “Hi, this is Dr. Stanger. I was paged.”
I survived my first night of call.
It is beyond my limited skills as a writer to describe those first 24 hours of my life as a physician. In our hospital, as the intern on call, you are the "house officer" overnight. That means that you are in charge of ALL of the patients in the hospital, with the exception of the ICU and the pregnant women. Too much responsibility to grasp, honestly. So I just rolled, responding to the pages vibrating my belt every 2 minutes. Running up and down the stairs. Listening to hearts, looking at bleeding wounds, fidgeting with IV lines, adjusting oxygen levels, placing central lines. Picking up a pen, writing orders, signing them, realizing that patients all over the hospital were swallowing drugs with massive effects on their heart rates, blood pressures, respiratory rates, all because I signed my name on a piece of paper. Words can't describe the rush, the paralyzing fear, the adrenaline raging through my veins. I spent the majority of my energy praying, over and over again, my mantra through the night -- "Please, Lord, don't let anyone die because of me. Please Lord...."
It was quite a night.
But then, somehow, miraculously, the sun rose. The hospital elevators rolled back to life. My doe-eyed co-interns appeared one by one, fumbling through the paper charts, staring blankly at nurses who approached with reports such as, “Doctor, your patient Mr Clark vomited 3 liters of dark green emesis last night. Can I feed him?” “Ummm…..” I brushed my teeth, picked up my clipboard from the untouched bed in the call room, and blearily turned to my notes from morning rounds the day before. Only one day into my rotation, everything seemed sunnier and somehow possible. I had survived. Now that the rest of the docs were here, my pager stopped going off every 2 minutes, and I managed to round on all six of my patients in just a few hours. Next thing I knew, it was 11 am, and I was walking out the front doors. Thirty hours later, thirty years wiser. And very very tired.
I like to think I’m tough, and these 30 hours shifts don’t touch me. That I’m somehow built for them, and that anyone who can’t is somehow weak or whiney or just doesn’t have the stuff. This is the only way that I get through it – taking some kind of false pride in the self-sacrifice, pretending to support 30 hour shifts in residency, citing statistics about the patient safety costs of increased sign-out with shorter shifts.
Clearly, this is an entirely transparent coping mechanism based on complete bullshit.
Working thirty hours shifts SUCKS. And no one is built for them. Yes, you get used to them. But they still suck balls. One of the easiest ways to get through them is to know that they will end – they always have before. And we all have our low points, entirely predictable, utterly uncontrollable. Some people cry, some become manic, some get strange rashes, some start calling exes. It’s bad news. For example, I know that I become completely useless between the hours of 2 am and sunrise. Nothing I can do about it, though sometimes eating a cookie helps, for some reason. But 2 am, oh it sucks. I will stare at a chart for 10 minutes, trying to multiple 15 mg times 60 kg. Just doesn’t work. Nothing stays in my brain. My eyes dry out, my head spins, my knees buckle, and for some reason I don’t medically understand, my entire pelvis aches. Strange, perhaps too personal, but true.
But then, mercifully, the sun comes up, the circadian rhythms kick in, and I coast through the morning. I eat breakfast, laugh with my co-residents, write orders, discharge patients, relish the fact that I get to go home so soon, imagining taking a cat nap and then going for a run. Maybe buy some groceries, work on my journal, play the guitar, go out for dinner. The world is my oyster at 10 am post-call.
But then there’s the drive home.
This is often the first time I’ve sat down in 24+ hours. And, inevitably, within 5 minutes, I am a disaster. My eyes blur, I start crying, my feet start twitching. It’s very bad news. It is these times when I thank God I chose to live in Walnut Creek, a 15 minute drive from the hospital, rather than Oakland which is closer to 30 minutes away. Yes, frankly, I hate Walnut Creek. I spend great energy trying to look on the bright side of my new hometown, try to appreciate its conveniences and sunshine and security and multitude of chain stores, but to be totally honest, I hate it here. I would kill for the cultural integrity of Oakland, the funkiness of Berkeley, the warm familiar rhythms of my beloved San Francisco. Sigh. But when I’m post-call, I am thanking my bourgeois butt that I sold out and lived closer to the hospital. Because I have about 30 minutes tops from leaving those front sliding glass doors of CCRMC and complete physical, emotional, and mental collapse. Good thing for everyone that this isn’t happening in the middle of the Caldecott Tunnel.
Case in point: upon returning home last Friday after my first call, I parked my car at 11:54 am and was in my bed, sound asleep, by 11:59. Slept like the dead until my alarm went off at 7 pm (I try to be sure to spend at least a couple of hours awake in the evenings, just for at least a gesture of normalcy). Woke up, felt surprisingly refreshed, and decided to make some delicious pasta primavera for dinner. Yum. So there I am, happily chopping zucchini, listening to Rodrigo and Gabriela and congratulating myself on what a fantastic doctor I am, singing high praises to the gods that I don’t have to work the next day and don’t have to see the hospital for at least 36 hours, when I gracefully and precisely slice directly through the meat of my left thumb.
Oh FUCK.
I grab my thumb with a napkin, pressing with all my might, praying it’s not as bad as it seemed, and gently raise the napkin. Shit shit shit. It’s deep, straight down the length of my thumb, and gushing out blood. Any 3rd year medical student could take one look at it, and correctly state that it meets all criteria for lacerations that require stitches. Fuck. I’ve never needed stitches in my life, and I manage to do this on the first day of my SURGERY rotation. I’m supposed to be scrubbing into at least one operation every day, first-assisting my surgeon, and I’m technically not even supposed to enter the OR with so much as a scratch. And now I have the end-all-be-all of geysers shooting out of my thumb. Dammit. Strong work, Dr. Stanger.
But the worst part of it all was that I needed stitches..... and that would require going back to the hospital. I just couldn’t do it. Blood loss and scars be damned. I could not walk back into that building on my day off. Instead, in perhaps not my wisest decision of the month, I opted for some creative Band-Aiding, and a prayer. Woke up the next morning with a blood-stained pillow, but reattempted my Band-Aiding, and it stuck. Did ok until the next day when I was scrubbed into an operation, looked down at my (double-gloved) hand, and realized I was bleeding underneath the glove. For those not familiar with sterile technique, this is VERY bad form. Hmm. I discretely scrubbed out of the case, hopped into the elevator, rode down to the tribe of hot married doctors manning the emergency room, and told them my sad story. God bless their hot little hearts, they jumped right on me, testosterone raging, each eager to come up with his own perfect solution to my thumb-bleeding/needing-to-scrub-predicament. In the end, I walked happily out of the ER, my thumb plastered with a healthy layer of SuperGlue, and my spirits restored. Post-call thumb-slicing disaster averted. Back to the battlefield.
This is Dr. Stanger. I was paged.
