I’m convinced I’m a white cloud, and I’d like to know how to change that.
“White cloud” is residents’ slang for a person who doesn’t seem to have patients come in, surgeries or codes happen, or patients transfer to the ICU or die on them. I think it really developed more as a corollary to the original phrase, “black cloud,” which is someone who attracts bad luck: when they’re on call, their team picks up more than their fair share of new patients; their patients always go to the OR, or the ICU, or die.
Being a white cloud is nice for a while, since it means less work – fewer admissions, transfers, and postop orders to write. But it really adds up to worse education. Getting slammed all day and night with admissions and disasters isn’t fun while it’s happening, but it’s extremely educational. A quiet day where no one crashes, no disastrous transfers land on the doorstep, and almost no one gets admitted to your service is pleasant, but not useful.
As long ago as third year, I knew I was a white cloud. On OB, even though I was crazy to deliver babies, they would rarely come on my shift. When it was another student’s turn on labor and delivery, they’d have four or five babies in eight hours. When I was on, six women would labor for twelve hours, and five of them would deliver after I had to leave. On trauma as a student, the gunshot wounds always came in on other people’s nights. On medicine call, I always got rule-out chest pain and COPD exacerbations. The other students picked up the fancy autoimmune complications, complicated cardiac issues, new cancer diagnoses, and so on.
This year, for being nearly done with a surgical internship at a tertiary care center which routinely picks up the disasters of several counties and states surrounding, I have had remarkably few people die on my hands, and have been present for remarkably few emergency trips to the OR. It’s always on someone else’s service that the patients develop bleeding that requires operation, perforated viscus, mesenteric ischemia, intra-abdominal sepsis, etc, or come in hypotensive and coding from the transport. It’s nice, I suppose, because I really don’t like it when my patients crash.
But I can’t believe that this white cloud effect is going to persist for my entire career. If it is, I should start marketing myself as a means to reduce the morbidity and mortality of almost any operation. (And it’s not because I do anything special. One of the chiefs is extra-paranoid about her patients, and boasts of having the lowest morbidity/mortality as a result. I’m not that good.)
This weekend, of course, is a case in point. Last weekend, the team on call got slammed. They doubled their list, and spent half the weekend in the OR. Two or three people ended up in the ICU, and all kinds of drama occurred on the floor. But now that I’m on call, we had one admission and one OR. No disasters. Everyone got out of the unit. What’s up with that?
I really should start tallying the morbidity and mortality of my patients compared to my fellow interns. Either I need a bonus from the hospital for improving their statistics, or I should get rid of this superstition about white and black clouds.
I’m just afraid that the other shoe is going to drop sometime. Like in two months, when I’m alone at night, and patients will start doing things that I’ve never seen or heard of before, because I have such incredibly good luck on call.
(Actually, I do know how to change this. Go around talking about “quiet night,” “being bored,” and “nothing interesting in the ER.” This really works very well, so well that the rest of my team curses me every time they hear me say it; so I don’t do it so much anymore. It tends to produce four ER consults in a row, and two or three admissions at once. I’m not sure what it does to the ICU; I haven’t tried it there.)