At the beginning of the month, one of the interns told me, “Have fun with vascular. Every day on that service, by 4pm, I wanted to jump off the roof.” I told myself I was determined to keep a better attitude than that, and then made a note to see how long I could keep it up.

As you can tell from previous posts, I think it’s not too bad yet (although as an excuse for the other intern, perhaps less busy this month, in my usual white cloud style). Nevertheless, by 4-5pm, I start to cringe whenever anyone talks to me. Things invariably fall apart at this time of day. Postops hit the floor with urinary retention, hypertension, hypotension, tachycardia, bradycardia, lack of pain control, family members who need to be talked to. All of which I enjoy dealing with, but not all at the exact same time. Admissions come in, all needing stat labs (I think the lab shuts down between 5-7pm) and stat consults, to fellows and attendings who, just like us, are trying to leave the hospital. The people I’ve been trying to discharge all day have their nursing homes call to say, oh sorry [insert incomprehensible excuse] we can’t take the patient today, try again tomorrow; whereas the people I’d given up on discharging suddenly, at 5pm, have rides, family members, beds at rehab facilities, you name it, and now they need discharge orders, narcotic scripts, discharge summaries. The nurses, laudably, are putting their papers in order before night shift comes in, which produces a flood of “the patient takes this different dosage/brand of medication,” “did you want normal saline or half normal saline?” “did you really mean to stop the iv fluids?” “why did we change the antihypertensive meds?” “blood pressure isn’t controlled, did you see the most recent vitals, can you order something else?” and so on. All good and necessary, but please not all half an hour before what might be the end of my day.

Going out to the parking garage, an elevator full of people started discussing what they would do if they won the lottery. Quit working at the hospital was at the top of everyone’s list (understandable, in a crowd that like me routinely leaves at 7pm). And I was thinking: if by some miracle I won the lottery (miracle because I never play), would I actually quit this job? I mean, it would be nice to sleep in (a whole group of surgery residents spent ten minutes the other day rhapsodizing to the med students about how nice sleep is, how much fun it is, how we completely underestimated it prior to starting internship, and how we now fantasize about it more than about eating or doing any other relaxing activity), and be able to do things on weekends. But really, life would be boring like that. Not be able to do surgery? Not have the pressure of life and death decisions? Not have to wake up for something every morning? Between the challenge and the authority that this job gives, I don’t think I’d quit.

(Which is why it doesn’t really matter what happens at the end of the day. So I leave an hour later. It doesn’t make any difference. I come home, eat dinner, write on here, try to keep my eyes open on the textbook, and then succumb to the allure of sleep. All the same.)