Somebody, somewhere in the hospital, has offended the trauma gods. I think it might be the chief, because whatever service she’s on tends to just get rained on, with crazy admissions, weird procedures, and spectacular complications. The night started off with four traumas on top of each other (which Brad and I only showed up to accidentally, because the pages looked so similar we assumed it was just one patient being announced several times), and progressed in a similar fashion, with at least one call every hour, often two or three at a time. We wound up with a trauma code, which is supposed to mean a patient in really serious condition. This one wasn’t at all, which was kind of the last straw to ruin the chief’s night. After getting all keyed up, for one trauma after another, it’s somehow crushing when nothing actually happens. You feel kind of useless, as though all your energy and choreographed teamwork is really pointless.

Brad is starting to get on my nerves. He hands out both compliments and abuse all night, and I never know where I stand with him. It’s probably dependent on whether he’s just gotten a string of serious calls from the ICU before I show up to bother him, or not. But even so, I’m still admiring his thoroughness in evaluating patients. He leaves no stone unturned. Patient was transferred at 2am from a remote hospital three hours away in another state? Great; call that hospital, track down the sole live person in the medical record department at night, and have the patient’s operation report from four years ago faxed over – already. The patient had cancer twenty years ago? Find out who treated them for it and with what regimen. A CT angiogram? He’ll pore through every piece of the film, flipping back and forth till he has a complete mental image of every major vessel. CT of the abdomen? He looks at every organ system, up and down, not just the abnormalities that jump out at you, or the organ system that caused us to get the CT in the first place. Such mental discipline is still a step beyond me; and I need to acquire it.

I owe my medical student an apology. There wasn’t much with my patients at the beginning of the night, so I sent him to get dinner, and promised to page him if anything came up. But somehow, when I’m struggling to figure out why a patient’s heart rate has, in one hour, jumped from 100 to 150, and why his mental status is deteriorating nearly as fast, paging Brad is all I can manage. The student’s existence unfortunately skips my mind, until we’ve got things calmed down. Which was no doubt ok with this student; if he’d really wanted to see things, he would have stuck around. Out of sight, out of mind; unfair as it may be, if you’re a medical student wanting to experience things as they happen, hoping to be paged is not an efficient way to stay informed. (And it is unfair; I know, because I was you, 12 months ago.)

One thing I have accomplished this month: I’ve gotten the nurses on three or four floors to recognize me and call me by my first name. “Dr. Alice” is fun, but plain Alice is better, because it means they know me and we’re working as a team, rather than me being just another blank white coat. (The ER secretaries know my name too – that’s not quite as desirable.)

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