Overnight Call
'Call' is one of those words that, if you say it repeatedly, starts to lose its meaning. I can attest that about 3:30 in the morning, most things start to lose meaning. And one starts to question whether one was meant to be in this medicine business.
I feel like I've been struggling to make an impression with the residents on the Orthopaedics service. Part of it is because they've sent me to the OR a couple days, where I interact with only one resident, or I've been scheduled for a clinic that didn't happen, or I've got some reading time. So I figured I'd change things up a bit by opting to stay with the on-call team Friday night. I figured this was the best day for a couple of reasons, first of all I get along pretty well with the residents taking call that night, and second of all that means I can go home Saturday as soon as morning rounds are over.
They tend to let us do more during surgery. Students don't do anything major, but they'll let us do more routine stuff that takes only a little practice. I can put in a Foley catheter pretty easily now - and if anyone wants a demonstration or would like to volunteer for practice, just let me know, I can do it rather painlessly (of course, it helps if the subject is unconscious under general endotracheal anesthesia).
Anyway, by 6:30 pm or so, most of the Orthopaedics residents are gone, so the call team is around to take care of any patients on the floors and to answer any pages by the Emergency Department. One thing I've noticed so far is that of the 16 beds or so in the Surgical Intensive Care Unit (SICU), almost half are filled with Ortho patients. I suppose it only makes sense that these most of these people have "MVC" next to their names, "MVC" being short for "Motor Vehicle Collision." It's astounding how many of these patients are on the service; it's almost like there's an epidemic of crappy drivers out there. Oh, waitaminute, this is Boston. Never mind.
Back to Call night. Things start off pretty slowly, only a couple Ortho consults here and there until midnight. We see a woman with a broken radius because she blocked a kick from her mad boyfriend. We see a young boy with a broken pinky because he threw a punch at - and connected with - another kid's face. Other than helping the team put on some casts, I'm able to spend most of my time doing my surgery reading. That lasts until about midnight, when I run out of steam - at that point I'm reading words, but they have no meaning, so I just lie back and close my eyes. Then the team gets hit - hard. Consults come in - not all at once, thank goodness, but steadily and without pause.
So far, the patients fall into one of three categories: Pure Accident, Fracture due to Co-Morbidity, and Human Stupidity. Pure accidents include a young man with a ruptured Achilles tendon - occurred when he was playing basketball in the gym, he jumped and landed and there it went. Pure accident. Bad news. Good news is that I'll probably get to watch the surgery in a couple days. Another 'Accidental' is a young man who broke his thumb playing soccer. The distal joint of the proximal phalanx of his thumb has been crushed into the rest of the bone. The Orthopods have to pull it out. They numb the finger with a digital block, but this is only so effective in the thumb. Ooooo, just watching them pull this joint into alignment hurts. Poor kid.
Then we see some people who have broken bones because of other diseases. These would include cancer patients who present with metastases in their bone, or elderly patients with osteoporosis. The frustrating cases are the 'Stupidity' ones - car accidents, violence, or other stupid human events. I think it's these cases that drive the Ortho intern absolutely crazy. This poor guy is the most jaded doctor I've met during third year. He's close to quitting altogether. Merely walking down the hall seems to piss him off. He asks me why I want to go into Medicine, and I mention that I like the patients. "I used to love my patients during third year. Now I f$#@ing hate them." I'm scared I might end up like him.
Around 4AM I'm starting to feel the effects of having no sleep. I'm definitely a newbie at this, and the residents are amused. "You'll get the hang of it," they say. I hope so...I think. Not only am I feeling exhausted, but I'm starting to feel pretty grimy. I wonder what I'm going to do first when I get home - shower or hit the sack. Angry Intern recommends showering. "Always shower when you get home - you have to wash off the MRSA." Ooh, gross. Now I feel even more grimy. Things get hectic about now - we have to finish with the patients on your consult list, round on a set of patients in the other hospital across campus, then be ready to round with the weekend Ortho team back at the home office. Activity tends to wake me up, and I'm Johnny-on-the Spot with the bandages and medical tape when the team needs to change dressings. When we get back to the office to round I sit down, and that pretty much puts an end to my functionality for the night.
The team sends me home around 9:30 Saturday morning. I'm groggy, but feel okay to drive home. I shower, then sleep until late afternoon. Yup, my Saturday is pretty much wasted.
I feel like I've been struggling to make an impression with the residents on the Orthopaedics service. Part of it is because they've sent me to the OR a couple days, where I interact with only one resident, or I've been scheduled for a clinic that didn't happen, or I've got some reading time. So I figured I'd change things up a bit by opting to stay with the on-call team Friday night. I figured this was the best day for a couple of reasons, first of all I get along pretty well with the residents taking call that night, and second of all that means I can go home Saturday as soon as morning rounds are over.
They tend to let us do more during surgery. Students don't do anything major, but they'll let us do more routine stuff that takes only a little practice. I can put in a Foley catheter pretty easily now - and if anyone wants a demonstration or would like to volunteer for practice, just let me know, I can do it rather painlessly (of course, it helps if the subject is unconscious under general endotracheal anesthesia).
Anyway, by 6:30 pm or so, most of the Orthopaedics residents are gone, so the call team is around to take care of any patients on the floors and to answer any pages by the Emergency Department. One thing I've noticed so far is that of the 16 beds or so in the Surgical Intensive Care Unit (SICU), almost half are filled with Ortho patients. I suppose it only makes sense that these most of these people have "MVC" next to their names, "MVC" being short for "Motor Vehicle Collision." It's astounding how many of these patients are on the service; it's almost like there's an epidemic of crappy drivers out there. Oh, waitaminute, this is Boston. Never mind.
Back to Call night. Things start off pretty slowly, only a couple Ortho consults here and there until midnight. We see a woman with a broken radius because she blocked a kick from her mad boyfriend. We see a young boy with a broken pinky because he threw a punch at - and connected with - another kid's face. Other than helping the team put on some casts, I'm able to spend most of my time doing my surgery reading. That lasts until about midnight, when I run out of steam - at that point I'm reading words, but they have no meaning, so I just lie back and close my eyes. Then the team gets hit - hard. Consults come in - not all at once, thank goodness, but steadily and without pause.
So far, the patients fall into one of three categories: Pure Accident, Fracture due to Co-Morbidity, and Human Stupidity. Pure accidents include a young man with a ruptured Achilles tendon - occurred when he was playing basketball in the gym, he jumped and landed and there it went. Pure accident. Bad news. Good news is that I'll probably get to watch the surgery in a couple days. Another 'Accidental' is a young man who broke his thumb playing soccer. The distal joint of the proximal phalanx of his thumb has been crushed into the rest of the bone. The Orthopods have to pull it out. They numb the finger with a digital block, but this is only so effective in the thumb. Ooooo, just watching them pull this joint into alignment hurts. Poor kid.
Then we see some people who have broken bones because of other diseases. These would include cancer patients who present with metastases in their bone, or elderly patients with osteoporosis. The frustrating cases are the 'Stupidity' ones - car accidents, violence, or other stupid human events. I think it's these cases that drive the Ortho intern absolutely crazy. This poor guy is the most jaded doctor I've met during third year. He's close to quitting altogether. Merely walking down the hall seems to piss him off. He asks me why I want to go into Medicine, and I mention that I like the patients. "I used to love my patients during third year. Now I f$#@ing hate them." I'm scared I might end up like him.
Around 4AM I'm starting to feel the effects of having no sleep. I'm definitely a newbie at this, and the residents are amused. "You'll get the hang of it," they say. I hope so...I think. Not only am I feeling exhausted, but I'm starting to feel pretty grimy. I wonder what I'm going to do first when I get home - shower or hit the sack. Angry Intern recommends showering. "Always shower when you get home - you have to wash off the MRSA." Ooh, gross. Now I feel even more grimy. Things get hectic about now - we have to finish with the patients on your consult list, round on a set of patients in the other hospital across campus, then be ready to round with the weekend Ortho team back at the home office. Activity tends to wake me up, and I'm Johnny-on-the Spot with the bandages and medical tape when the team needs to change dressings. When we get back to the office to round I sit down, and that pretty much puts an end to my functionality for the night.
The team sends me home around 9:30 Saturday morning. I'm groggy, but feel okay to drive home. I shower, then sleep until late afternoon. Yup, my Saturday is pretty much wasted.
posted by Mikey at 11:00 AM
2 Comments:
hi,
i guess u will enjoy the orthopaedic posting.The environment,the feel,the pride ,the courage.its a mix of all that and a lot moreeeeeeee.no doubt its hectic but at the end of the day you feel satisfied,,isnt it ????????
I'm enjoying my Orthopaedics elective, but probably not so much that I find it to be my calling. I like the people, but the environment can be rather malignant, at least here in the US. And yes, the Orthopaedic surgeons have pride. Lots to spare :)
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