I spent a large part of the night, in my capacity as plastic surgery consultant, watching the trauma team and the neurosurgeons handle a stream of disasters. I would get a perfunctory consult, because of a broken orbit or zygomatic arch, or maybe a few small lacerations, but I wasn’t about to take up the time to look at the patient or sew things neatly while the neurosurgeons were discussing how fast they could get the subdural or epidural hematoma into the OR. Then there was the poor guy who came in with his face streaming blood and an unstable airway which took the longest time to get control of. I stayed around, because I figured with his face looking like that, there would be a plastic surgery consult forthcoming. When we finally got to the CT, everyone was amazed to see that the bones were just fine (though not much else was). Which was ok with me.

I continue to admire and take notes on the senior residents’ manner of handling emergencies. Hands in pockets seems to be a ubiquitous theme, and a practice which I will have to adopt. It seems to promote a certain shoulders-back, distanced-enough-to-think-calmly stance, which I could use. (Not, you understand, when there’s any thing which actively needs to be done. The point is to keep your hands still if they’re not needed. One thing I learned quickly as a medical student is that you should not put your hands in your pockets as a student on a surgery rotation, because it implies that you’re uninterested, and not available to do things like rectal exams, foleys, and cleaning up whatever messes need cleaned up.) Pockets, and standing at the foot of the bed, where you can survey the situation and not get in the nurses’ way, and standing still, rather than pacing back and forth.

At the beginning of the year, I got a long way by pretending to be a doctor – and here I am, actually a doctor, feeling like one, and acting like one without having to pretend. So I think for next year we’ll go with the same plan: pretend to be a junior surgery resident, calm, unfazed, knowing what to do next, and hopefully within a few months it will be true.

I’m 3/4s done with The ICU Book, which will have to do for now. Tomorrow night I plan to sleep as much as possible, and then the same all day; which will hopefully help me to flip my circadian clock 180 degrees within 24 hours. The only good thing about this entire scheme (surgery residency and all) is that I seem to be good at falling asleep anywhere, anytime, at the drop of a hat. Being at night and having a bed are nice if they happen, but not necessary.

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