Today there was only one minor trauma, right at 7 am, and nothing else happening for the rest of the day. Still lacking the courage to try to get into the OR, I went to the ICU, and quickly found the two ICU residents outside a patient’s room. They were discussing their schedules. One of them was distressed because his wife, who takes care of their two children, complains that he never gets home. He leaves at 5 am, and gets back at 8pm, and goes to sleep, and has maybe one day off a week, never a whole weekend. The residents do two months at a time, so he’s on this trauma schedule for two months, and then somehow got a back-to-back schedule, so it will be four months before he has a weekend off, or gets home before 7pm. His wife is understandably upset about this. She wants a few days for the family to go visit her parents, but the residency director told him, he’s already had enough time off, and forget about it. Finally he turned to me and said, “Have you really thought about what you’re doing? Get out of this while you still can.”

Later on, still on the same subject, he was telling his friend, “I don’t mind the hours that much for myself. But I hate what it does to my wife. When she’s behind me, I can do anything. But I can’t go on like this.” I wish she, and the other wives of residents, could have heard him.

In spite of his problems, he took me around with him, checking on his patients, explaining things to me, and asking me questions. He asked me such good questions, that when the attending was rounding with them, and started pimping me, I got almost all of his questions right. So finally he turned to the residents and said, “We need to think of some more questions, this isn’t working,” meaning he couldn’t trip me up. So the resident and I winked at each other.

I learned so much today. I can’t think of a book where all this would be written down; but by context and osmosis, I’m learning all the abbreviations for vent settings and management, and what to go up or down on, when a patient is acidotic, or not oxygenating well; and common complications in ICU patients (pneumonia, PEs, ARDS, C diff. colitis), and the treatments; and how surgeons manage abdominal incisions that they can’t close, and have to put vacuums on them, and then graft skin over them. In the afternoon, one of the patients, a guy who got stabbed in the abdomen two weeks ago, and has an open belly, took a turn for the worse. They got a CT scan, which showed pneumonia, ARDS, and a large pneumothorax. So, he got the works: a new chest tube, several attempts at starting an arterial line (to draw arterial blood gases without sticking him every few hours as the vent settings are adjusted) which concluded with the attending failing repeatedly, and my resident succeeding, a failed attempt at a subclavian line, and a femoral line. Oh, and a bronchoscopy, to evalute what bacteria he’s got, and clear the airways out some. That took about three hours. Partway through we took a break, to let his girlfriend and parents come in, and hear what was happening. His girlfriend was tragic. She’s a respiratory therapist at another hospital; so part of the time she was trying to be professional, and talk calmly with the therapist in the room, and explain the medical terms to his parents, and part of the time she would be trying to cry quietly.

Time to go to bed, so I can’t tell about the other patients I saw. Just one lady, who I’m concerned about. She’s awake, but with a tube in, so she can’t talk. And the doctors started talking outside of her room, walked in, still talking, didn’t even say hello to her, and walked out again; with her watching them pitifully all the time. That’s horrible, by them, and for her. Tomorrow, if I have any free time at all, I’ll take my Bible and my pocket mystery book up, and offer to read one of them for her – since we can’t really converse!

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