I got to the hospital much earlier than my usual slack hours lately to see the patients from yesterday before getting to ortho grand rounds for a visiting professor from Europe who spoke in a thick accent with a stutter on some key point of shoulder management. Dr. Ashley was very interested. I was very bored. Two of the patients were doing fine, but one was in a good deal of pain. She had been very nauseated by the primary medicine we’d written for her, and had been struggling for most of the night with the second medication and something for nausea which was different than her usual. I think she already had some narcotic tolerance, so the doses weren’t enough anyway. I felt very bad after talking to her. If I were a resident, they would have paged me already in the middle of the night, and she might not have had to be miserable for so long. And if I were a resident, I could have changed the orders right away after talking to her, rather than having to wait another hour for Dr. Ashley to come around. I occupied myself in lecture by trying to figure out, if someone had asked me, what I would have changed the orders to. . . do I really want to be a resident? Hmmph.

Then we all drove over to the VA separately. Dr. Ashley had from somewhere acquired a real resident for the day, who happens to be another very nice guy (not the intern) who knows me. He found me wandering around the OR section of the VA, which has no directions posted in it, and tried to help me get some scrubs. I needed his help. This is how the VA works: Lady at control desk: Who’s that?
Resident: She’s a medical student who’s going to be scrubbing with Dr. Ashley today. She needs some scrubs.
Lady (bored and skeptical): She needs to be cleared for the OR first. Have you got surgical clearance?
Me (too honest for my own good): No, not really.
Lady: Go talk to Linda, Marilyn or Joan.
Resident: Where are they?
Lady: They’re all on vacation today.
Resident: Then who should we talk to?
Lady: You could try Mark.
Resident: Where’s he?
Lady: He’ll be around Linda’s office. Through those doors and two corners around.

We proceed through three double doors.
Mark: What do you need?
Me: I guess I need surgical clearance.
Mark (very frustrated): Well, you would need to see Linda, Marilyn, or Joan.
Resident: Is any of them here?
Mark (throwing his hands in the air; I think it was already a bad day before we arrived): No, they’re all gone for the holiday. (silent implication that we should go away too and stop bothering him)
Resident: This student needs to scrub with Dr. Ashley today.
Mark: You can’t bring someone here just for one day.
Resident (a little louder): Dr. Ashley only comes here a few times a month. You need to get this straightened out.
Mark: She needs to sign some privacy forms.
Me (trying to redeem the earlier tactical error): I signed all of those in January.
Mark: Maybe they’re different for the OR.
Resident: It’s a privacy form, right? She already signed it.
Mark: Maybe she needs to sign it again.
Resident and me in chorus: It was within the last year!!!
Mark (walking to the door): Go talk to Dr. Jones, over there. He’s in charge.

We walk back in front of the first desk, and wait for Dr. Jones to finish a conversation.
Dr. Jones: Can I help you?
Resident: This medical student needs to scrub with Dr. Ashley today, and the people who give clearances for the OR are gone today, and somebody suggested you could help us. (The resident was a very diplomatic guy.)
Dr. Jones: Sure, no problem, go ahead. Missy (to the original lady at the desk), this young lady needs some scrubs.
Dr. Jones walks off through three double doors.
Lady (to his back): Doesn’t she need to sign some papers?
Resident: He said she could have the scrubs, ok?
Lady (sighing and standing up): Do you need medium or small?
Me (firmly; I insist on loose scrubs): Large, please.
Lady: Are you sure? The paper scrubs are cut fairly large.
Resident (after a pause): Paper? She needs real scrubs!
Lady: I can get her some paper scrubs. They’re right back here.
Resident (losing the diplomacy): She is scrubbing in a total joint with Dr. Ashley! She needs real scrubs!
Lady: I’m not sure if we have any.
Resident: Dr. Ashley will be very upset. She can’t be in a total joint in paper scrubs. I am sure you have some real scrubs somewhere.
Lady (condescendingly): I don’t know, but we can look.

We proceed around some more corners, where she unlocks two doors and reveals a supply room with several shelves of labeled scrubs.

I won’t go into the next act in detail, but it involved one competent scrub nurse assisted by a circulator who sounded as though she’d never participated in a total joint before; the wrong set of instruments being sent up (for a totally different joint than the scheduled one); a CRNA student who couldn’t intubate the patient (yes, I know, I’m not one to talk); and other idiosyncrasies of the VA, which added up to the case starting an hour later than scheduled (in spite of the helpful lady at the desk, I was ready ten minutes before the scheduled time). Once we got started, it went smoothly enough. The resident was able to do most of the surgery, and I didn’t do anything particularly dumb other than be unable to keep the retractor in place, which is old news. Before I left, the resident wrote me down the name of a book which apparently reveals how to manage all fractures, particularly if you are unable to operate on them. Why does everyone who hears about my missionary plans jump to advise me about orthopedics? At least he had some useful advice.