Another memory that sticks out from my third year surgery rotation was the night I was on call with the trauma night chief. Nights at that hospital, the trauma service was responsible for all ER consults and emergency surgeries, as well as a fairly busy knife and gun club, and several major highways and intersections. So they had their hands full. The trauma chief had his own hospital-provided phone, because he made and received so many calls that it would have been impossible to function with a beeper alone.

There was one patient he was trying to see in the ER, to explain the reasons for doing or not doing surgery (I forget by now which one it was). The phone went off about three times in four minutes, and finally he handed me the phone and said, “Please take this thing out of the room and take care of it for me for a couple of minutes.” In the next five minutes, I answered four more calls and took notes along the lines of, “The patient in ICU 13 just got reintubated.” “The OR will be ready for you in fifteen minutes.” “The trauma patient in ER 34 is having increasing pain and tachycardia, what does he want us to do?” “The xray on ICU 14 came back, the feeding tube is in the wrong place, please come change it.”

When he came back for the phone, he seemed to think that wasn’t too bad of a haul. And I thought, I was ready to pull my hair out, just holding the phone and taking messages for five minutes. Am I ever going to be able to handle this in real life?

And here I am, taking pretty much the same kind and volume of calls, and so far nothing’s fallen apart. I’m not looking forward to doing this overnight, and the prospect of two years’ worth is rather depressing – but one day at a time, it’s not too bad. Eight or ten consults in eight hours, one to the OR, not too horrible. The ICUs had the sense not to make much noise, which helped. I made the ER resident quite furious by declining to admit one patient, and insisting on sending it to medicine; the fact that I got another patient into the OR in half an hour didn’t make him much happier. Most of the trouble came from the medical ICU, which gave me half a dozen perfectly useless consults, of the kind where I had to spend five or ten minutes simply figuring out why on earth they had consulted me (usually it turned out to be a reason they were unaware of, eg their consult order listed abdominal distention, whereas the patient was having GI bleeding, and really needed a GI consult, or the order listed GI bleeding, and what they really had was gallstones). Then I had to call the attending on those, and he got upset at me for wasting his time with such nonsense. Which is why within a couple of months I can see myself being quite crushing to the MICU residents if they call me with such things.