This morning, after sitting through an amazing number of hours of lecture (which did make up for some sleep I missed last night), I was delighted to discover an epidural hematoma evacuation that had been added on. (For interns, as for med students, tracking OR cases is like a delicate exercise in military intelligence, involving keeping your antenna tuned to covert communications and cultivating sources inside the camp; the only good thing is that interns have a little better access to sources.) The chief again let me make the incision, do a lot of the drilling, some of the hemostasis after the clot had been removed, and screwing the bone back down. I cannot believe this guy. He let me do so much. Even when I was doing really ridiculous things, like holding the screwdriver wrong, or holding the forceps wrong (which I ought to know better by now), he somehow managed to correct me in an encouraging way. He would tell the scrub tech things like, “Dr. Alice will be placing the bone flap in a few minutes, when she’s done drying off these bleeders.” It sounds silly, but the plain idea of me being about to do anything as purposeful as that, and announcing it ahead of time, was fun.
Then I ended up somehow with the call pager again (with unheard of good fortune for an intern, my beepers didn’t go off while I was in the OR; this is contrary to all statistical laws, which dictate that as soon as you get near a chair, a cafeteria, a bed, a bathroom, or a scalpel, the beeper must go off). I can understand a little why the resident I’ve worked with the most seems so scatterbrained. Getting paged every two minutes, about things which are all important, and all require about 45 minutes to deal with, is rather nerve-wracking. I was trying to be organized, but my method of organization somehow ended up with me postponing till last yet another epidural hematoma in the ER, which of course I should have seen first. (The fact that the trauma team mistakenly called it in as a stable subdural may have contributed to that mistake. I suppose that would explain why the obnoxious resident acted as though general surgeons can’t tell the difference between epidurals and subdurals. Classically, and when big enough, these two are supposed to look rather different on CT. When small, it can occasionally be difficult to tell which is which.)
Yesterday one of the attendings amused himself by catching a fresh medical student and sending him off on incredibly complicated mission to coordinate a plan of care on a critically ill patient between three different surgery services. We residents watched the student set off with a look of determination, and smiled to ourselves. (We did then sort it out ourselves, explain to the attending, and fish out the student; but it was funny. And the student was setting himself up for it.) At least, it was funny yesterday. Today, another attending discovered me on the end of the call pager, made a few remarks about why he had to get stuck with the rookie in an emergency, and sent me off on a similarly hopeless mission with instructions to call back in two minutes. I think I must have looked rather like the med student. . . Serves me right for being amused. (It turned out fine.)
I stayed late for the second epidural hematoma, but a different senior was in charge, and he didn’t let me do a single thing. I had to stand there and admire his clever ways of doing things (which somehow, as far as I can see, never turn out quite as clever as he expects). I was upset with myself for expecting any better, because I know what this guy is like. Note to self: how to encourage and teach interns. I think the chief could let me do as much as he did because he knew for sure that he could handle the whole thing easily himself. It takes a lot of confidence to be able to let go and let an incompetent junior putz around for a while. I hope I get to be good enough that I can teach others that way.