My plan for the last night of March was to keep things quiet, get some sleep, and study up for a laparoscopic procedure that I had been semi-promised on my new service the next day. Semi-promised, as in, “X procedure. . . you do know how to do that, right? [alarmed] Have you ever done one of those?” Me: “Oh yes, sure – at least, I did one.” So every time the junior residents saw me, they egged me on to make sure I did the case, and every time the chiefs saw me, they expressed skepticism over the wisdom of the plan, coming off of nights, a complicated patient, and so on, and reassured me that one of them could do it if I couldn’t. Needless to say, after a very few of these conversations, I was quite determined to do the case no matter how tired I was. After all, in three years, as a chief, I’ll need to be able to operate after being up 24 hours or more, not to mention what is likely to happen in private practice. (That’s how I persuaded myself I wasn’t needlessly endangering the patient.)

Of course, the night wasn’t quiet. I had shared responsibility for one patient, and individual responsibility for another patient, who both crashed and went emergently to the OR at the same time. My particular patient was bleeding dramatically – the kind where you transfuse massive amounts of blood, and the hemoglobin comes back lower than when you started; and when you open in the OR, the floor gets covered with blood. I did my best to do hands-in-the-pockets, and thanks partly to that, and to the fact that it was actually a straightforward case – the only thing to do was give blood and go back to the OR - and to the attending turning up quickly when called, the patient did just fine. But even after the OR, I still had to spend a lot of time in the patient’s room, talking with the nurse, doublechecking orders and labs. So I slept for maybe an hour altogether, and had no time to study for the case.

Fortunately, after four hours of mandatory lecture, the case was delayed for a little while, so I had a chance to go read. It was good I did, because the way I had assumed the procedure should be done was incorrect, and there was a fair amount of background material which I ought to know, and which it made me feel much more confident to face the attending, having read. The case went fairly well; as in, it took twice as long as it ought to have, and there was a slightly larger blood loss than usual (usual being 20cc, that’s ok). It was complicated, for me, by the presence of a new medical student. She did her absolute best to keep the camera in focus and to follow my movements; but the result was that it bounced worse than any other med student I’ve seen this year; and when I already felt a little unsteady on my feet, and was trying to do the most delicate maneuvers I’ve tried yet, laparoscopically – it was all I could do not to snap at her. But as in the parable of the unforgiving debtor, what could I say, when the attending was silently putting up with my infuriating slowness and blundering?

Finally, I had to leave late in the evening, signing out a rather unstable patient to the new night float. The intern on this month is one of the program’s characters. He’s ten times as competent as I am, and I completely trust him to take care of my patients. The trick is that his good care will be quite unorthodox, and I’m sure I’ll be in for some surprises when I get back in the morning and see what his management has been overnight. And then I’ll have to explain to my chief and attendings, who will somehow hold me responsible for all events. Ah well. Have to let go sometimes.

Time to go read a little bit; we’ve been warned of pimping sure to occur tomorrow, and having been warned, it would be unforgiveable to be unprepared.

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