I was “on call” July 1st, but after today, it’s clear that that wasn’t really call at all. Today was the first time my beeper kept going off nonstop, quite frequently while I was just starting to return the first page. After a couple of hours of that, I was no longer feeling wanted, but pestered.

Actually it was good. We were part way through plastics rounds when I got paged for a patient with a cold leg (I have a complex list of specialty services to cover for, including vascular). The plastics attendings grudgingly agreed that that was more important than me staying for the rest of rounds, so I ran down to investigate, and was very relieved to find that an ICU resident had been consulted as well. I was quite satisfied to let him take care of the airway (barely patent) and circulation (bp around 70) while I considered the leg, for which I had been called, and the abdomen, for which I had not been called, but any surgeon should be interested in the possibility of ischemic bowel. I felt very stupid for not being able to find even a femoral pulse on either side, when the patient was obviously still semi-awake, and therefore ought to have at least central pulses. So I was relieved when my senior resident came along, and didn’t find any either, and explained that between the patient’s multiple previous vascular surgeries and current state of low perfusion, there shouldn’t have been any pulses there.

We had just finished explaining this consult to the vascular chief when we got another page: retroperitoneal hematoma, bp around 60. This one we cheerfully punted to interventional radiology (there is hardly ever a surgical response to retroperitoneal hematoma, since by opening a closed and pressurized space, you destroy the only thing (pressure) which had a chance of stopping the bleeding, and just create more space for the blood to pour into; radiologic embolization is the best chance usually), and I was relieved to once again dodge having to individually make decisions about a critical patient. In between, I admired the senior resident’s manner of talking with the family members of the first patient. He was firm and authoritative, but deftly positioned himself as being on their side, thus making them more confident in his advice, and more willing to accept, eventually, his request for a DNR order.

A little bit later, I got a page: “We tried to place a central line, but I think it’s in the wrong place.” I called the senior immediately, because since I’ve never put even one central line in, there was no way I was going to pretend to know where that one was. Instantly my beeper went off again: “The patient is bleeding, are you going to get up here?” Fortunately the senior made it there before I did, and the situation calmed down and became quite straightforward. I hope, I hope, I hope that the end result of this year is going to be me being half as calm and collected as he is. He very nicely explained all of these patients, and didn’t act as though I ought to know everything about them already, which was a relief.

 Meanwhile, the plastics service continued to accumulate one consult after another, and the ones we already had abandoned their heretofore well-established habit of recovering without complications, and began to spike temperatures and have pain control issues. So I spent the whole day running from one end of the hospital to the other, and managed to get at least one ER nurse seriously angry at me (she scowled at me every time I walked by for the next five hours; sorry ma’am, but after only two weeks, I don’t yet know all the intricacies for computer entering orders in the ER; maybe in another week or two!).

Perforce, with so much business, I had several chances to talk to patients and explain things to them or their families without the chief around. I think I do a fair job of being sympathetic and explaining things in non-medicalese. The only catch is that I’m so sympathetic and concerned about the fairly horrific injuries that the plastics team sees on call, I may be too depressing in my manner. Oh well. My third year medical student is at that very young stage where she’s very very concerned about every complaint of pain. Her notes are all about that, bless her heart, and she tells us every detail. I know I did the exact same thing when I was her age (all of two years ago). It takes a while to be able to say, yes, I’ll adjust the narcotic dosage, without feeling very disturbed about every incident. It is sad, perhaps, but we wouldn’t get anything done if we spent all day commiserating about simple pain; there’s fever, and paralysis, and loss of feeling, and open wounds, and infections to worry about, too. In another couple months maybe I’ll acquire my senior’s nonchalance about tachycardia, PVCs, and hypertension as well. (I think he still worries about hypotension; there’s too much of a hard bottom there to get comfortable.)

In other news, part of my first paycheck went towards furnishing the kitchen with some essential objects, like flour, sugar, baking powder, and spices. Result: gingerbread cake. Ahh! (This cake is useful because it doesn’t need an electric mixer, and can be cooked in any odd metal container which is bouncing around the kitchen. It’s so good, the container doesn’t matter. The recipe is in Joy of Cooking.)

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