Somewhat related to yesterday’s post:

Today was splendid. I spent the entire day in the OR, running from one thing to another, so much so that at the end of the day I realized with horror that I’d hardly paid any attention at all to my floor patients. Fortunately, they were all with good nurses, so I was able to reassure myself while scrubbed in that I would have been paged if anything had been wrong; and indeed they were all cruising along smoothly when I went to check after the cases were finished.

Anyway, I had a tremendous time, being with one of the attendings who doesn’t believe in giving constant instructions. He just kind of stands there (after very carefully marking the place to start; my blog’s title is no joke), and lets you call for the instruments from the tech, make the incision, and proceed as you see fit. He says something if you’re about to do something absolutely disastrous; otherwise, he just hums a little bit and smiles to himself. Since he’s slightly deaf, no little hints like murmuring, I s’pose this is where we go next, will get you any help. You have to say loudly, I’m not sure what to do next, if you want to get any directions; which is of course a surrender and an embarassment to say, so you keep trying. But so amazing to realize that I actually do know a great many useful things to do.

At the end of the day, rounding with the chief, he could see that I was enjoying myself vastly. He smiled at my account of the day’s proceedings and said, “You know, Alice, you’re going to have to pay for your fun eventually.”

What he meant was that all these cases were on the schedule because he and the attending had been called several times a night for the last five nights, the team being on call. All I had to do was admit a few patients in the afternoon, and see a longer list in the morning, and then I got to do cases. He was the one who’s been awakened by calls at home¬†several times a night for the last two years, and he and the attending were the ones who came in for emergency cases over the weekend. They’re tired.

And I was thinking. The chiefs at this program operate all day every day, it seems like. But they pay for it. They look pretty tired – noticeably more so now, at the end of the year, than at the beginning, when the cycle was just starting. They are never not able to do anything that’s called for; but they’re exhausted a lot, and they look like it. Most of them have grey hair. None of them are much past thirty, but they look older, especially after a string of days and nights with their attendings on call.

He’s right. I thought I was paying in advance, this year, doing all the pre-op and post-op work and not getting to operate. But next year, covering all the surgical patients at night, I’ll start paying; and after that, taking real call continuously – that’s when the bills come due. I’m worried about next year; but I’m even more scared of having a chief’s responsibilities. That’s only a little more than two years away. I need to stop doing math.