I was dreaming about a patient who needed emergency surgery or they were absolutely going to die, and there I was rushing around this nightmare hospital trying to find my resident and a surgeon and an anesthesiologist, and I couldn’t find anybody – and woke up to look at the alarm clock, and I was supposed to be at the hospital already.
So I ran out the door mumbling about the patient who was dying, and had been driving for five minutes before I calmed down and decided no one was going to die for lack of my presence, at least not yet. Actually everyone comes in late on Sundays, so I was only half an hour later than the resident, and since we didn’t have many patients she didn’t particularly mind. So I spent the last couple of hours trying to figure out the patients we’re covering for the other team. The half of our team which isn’t on call doesn’t come in on the weekend, so we have to see their patients, and write notes and orders for them. The idea is that they should have left clear instructions and notes so we can carry on their plans. They must have been tired yesterday, because it took us a long time to figure out their patients, and then we reversed half their orders. As in, one guy who appears to have a white count and a chest infiltrate, whom they didn’t put on antibiotics, and another guy with ileus (bad constipation) which resolved overnight, whom they did put on one of the big-gun antibiotics, I don’t know why. So we switched that around.
So now I have time for some psychoanalysis. Way back when I was a first year, I spent two weeks with an OB/GYN in private practice. He let me scrub in on his surgeries, though not touch anything, and that was enough to delight me back then. One day he and his partner were being paged frantically out of their scheduled gyn surgeries for a lady upstairs in labor and delivery. I went up with the younger partner to see. He found the lady, about 29 weeks pregnant, saying she hadn’t felt fetal movement since yesterday. She had come in then, been told the heart sounds were ok, and sent home. Still nothing moving, so she came back. When she was seen in the ER, there were fetal heart tones, but erratic, so she was sent upstairs. There, she was put in a room, and on a fetal monitor, and then the heart tones were lost, which was when the stat paging started. He listened and looked, and sure enough, no movements, no sounds. He started paging anesthesiology, but it took almost half an hour to get the staff there, start the epidural, and finally start the Csection. They pulled the baby out, and she was blue and white, not moving or crying. The nurses whisked her off to the NICU, but could do nothing. The doctor had to sew up the incisions, and nobody could say anything. Everybody but the mother had seen the baby, had heard it not crying, knew that if no one came in to say anything, that was it; and no one wanted to say it out loud while the mother still had to hold still for the surgery. After sewing up we went across to the NICU to look at the baby. She was white – dead white – cleaned and wrapped up. She was so beautiful; a little small, but not much, and absolutely perfect. No organs visibly missing, no holes – no reason to be dead. I felt like if someone would just hug her instead of laying her on the table and looking at her, maybe she would start crying. But no one could hold her, and she didn’t move.
So I’ve promised myself to learn how to start epidurals, so I never have to wait for anesthesiology if there’s a real emergency. There was a reason, of course – the OR was full that day, and some emergency surgeries had been started downstairs, which had used up the free CRNAs and residents; and maybe the baby wouldn’t have made it even if the Csection had started the minute the doctor saw the heart tones were gone. But I will not be dependent on anesthesia. I don’t want to see another little white baby like that.