This blog is getting way too boring, with no stories in it. Sometimes exciting things happen to me, but you’d be surprised how spread out they are. (At least, things that you’d consider interesting. I got to tie about a hundred knots today, and have half a dozen cases to put in my log for the last week, both records since the start of the year. But you don’t want to hear about how much fun it is when the needle slides in right where you want it, and when things are flowing smoothly enough that you can sew and tie faster than the attending.)
Awhile back, I met one of the most fearsome attendings at this hospital. He’s the kind of person who makes you wonder whether it’s worse to go to conference, and get chewed out in front of a large audience, or skip conference, and get massacred in a more private setting. (Thank God I don’t belong to his program, so I don’t have to worry about it too much.) He’s the kind of person the whole OR talks about behind his back, the kind who can get large blocks of employees to quit en masse.
The whole team of us were knee-deep in a burn case. The wounds that needed eschar (which is medicalese for scar) excised (cut out) and grafted with healthy skin were widely scattered, making room for a couple of interns and medical students to be busy at the same time. For a change, we had a happy scrub tech, one who wasn’t furious at having more than three people scrubbed in his case, and who actually thought ahead and asked for supplies before we needed them. The circulator and anesthesiologist were also quite chipper, and we were having almost a party in there. (It was also quite late, and we had gotten to the point of abandoning thoughts of going home or doing anything when we get there, which creates a kind of happy-go-lucky spirit.)
An older man walked into the room, half-holding a mask over his face. “Dr. Smith! I found your room. How’s it going?” He walked around the table, peeking over our shoulders. “This is quite a case you’ve got here. Those are extensive burns. How much, exactly?”
Since I’d admitted the patient, I felt that the question belonged to me. I wasn’t sure who was asking, but he looked like he had a right to ask – maybe one of the anesthesiology attendings checking to see how long till the room was freed up. “Well, what we wrote on the admission sheet was 20%. Something like that. It’s hard to tell, because it’s scattered all over like this.”
There was a pause. “Who was just talking to me?” he inquired, in a nonspecific tone of voice. Dr. Smith introduced me as rotating resident. Our visitor continued to circle the table, greeting the other residents and students, whom he knew. Then he asked, “So what kind of a fire was he in?” “There was no fire,” I blurted out. “Oh, I’ve got everything wrong today, huh?” he said. “Come on then, what was it, if not a fire?”
I could tell I’d missed something, but it was too late to draw back. “He was working in a factory, when a piece of machinery malfunctioned and spilled a ton of boiling water on the floor. He slipped and fell into it.”
The visitor nodded. “I see. And what’s his medical history? That looks like a chevron incision there.” [typically used to gain access for major liver surgery] “That’s exactly what I thought when I admitted him. But he told us he was injured by a knife when he fell down a flight of steps some twenty years ago. He was carrying a lot of laundry, you see, and there was this knife – I think it was left lying in the wrong place, or something – anyway, when he fell, it somehow ended up perpendicular to his liver. He had to have a formal resection to stop the bleeding.”
“He seems to have a knack for falling in the wrong places,” our visitor remarked before strolling out. And from the conversation that followed, I realized he was the notorious attending I’d been hearing about all month. There’s nothing like not knowing what you’re getting into to make an intern talk smart to a senior attending. Good thing I didn’t belong to him.