Not so bad for nights so far. Not much luck at making people come in to operate in the middle of the night, but no one but adrenaline junkies like me and the night float interns really mind that.

Speaking of adrenaline: somebody was messing the code pagers tonight. There was one real one, early on, at which I practiced not touching and not talking while the intern did the line (harder than you’d think), and verified that after working on three-hour long resuscitations on open-chest patients in the cardiac ICU, I no longer care very much what particular order the code drugs are pushed in. Epi; bicarb; calcium; is there a pulse? it must have been three or five minutes; more epi. . . And never let the fact that you got pulses once after CPR delude you into thinking that the pulses will still be there two minutes later.

Then there were several more code pages over the course of the night, none of which were real. In fact, for most of them, there wasn’t even a patient at the location we were sent to. I was never trying to sleep when it happened, so it didn’t bother me too much. I think the intern was mainly disappointed not to get any more lines.

I’ve also been carrying on a heated argument with the chief and attending on one particular service, for the whole month to date, about one particular patient. Every evening I come in and try to persuade them again of my diagnosis; and every morning the chief has some more barbed comments about my sad lack of clinical acumen (as demonstrated by my disagreeing with him). I think the final result is that I was half-right, and he was half-right; and of course each of us thinks our half was the more important. (I was right that the patient needed surgery; he was right that I had the wrong diagnosis.) Note to self, there’s no percentage in fighting with a chief; but next time I’ll show him. . .

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