Call #1
I am on call tonight.
Call is this horrible thing that happens to you when you’re a doctor. It essentially means that if there’s an issue with one of the patients, the nurses can “call” you. All night long, baby.
In my residency program, interns are on call q4. What does that mean? Well, in medicine, “q” means “every” (it’s probably a Latin thing) and “4” means “4”. Put it all together and this means that I’m on call every four nights. Every four nights, I get to spend the entire night at the hospital answering questions about patients and admitting sick people.
To be honest, I’m the teensiest bit excited about it. I mean, this is what being a doctor is all about. This is what I’ve been waiting for. And now I’m the one in charge. I get to make important decisions, cure sickness, maybe even save lives. This is what I was writing about on that med school admissions essay.
(Excerpt from Jane McGill’s med school admissions essay: Illness is a treacherous dragon, breathing fire on innocent patients, and as a physician, I want to be the shining knight who battles that dragon and saves my patients’ lives.)
(No, really. I wrote that. In my defense, I was only 21 at the time.)
I enter the hospital at 7:25 a.m., wearing a fresh set of green scrubs and a new white coat that is as yet unstained. Today I’m definitely going to be on the lookout for flowers, that’s for sure. I’m wearing my comfy Dansko clogs, knowing that I will probably spend the next 24+ hours on my feet.
Overnight calls in our hospital last 3O hours. Alyssa has told me to come no earlier than 7:3O a.m., so that I can stay until 1:3O p.m. tomorrow. County Hospital is very strict about us sticking to the 3O-hour rule, because the hospital could get slapped with a big fine if we stay in the hospital longer than 3O hours. Along the line, someone discovered that tired residents perform at roughly the same level of competency as drunk people, so now there’s something called the Bell Commission, which ensures there aren’t a bunch of drunk people caring for patients.
In case you’re interested in the history of the Bell Commission, it all dates back to the olden days of medicine. Back then, residents would go for weeks at a time without sleeping, eating, or using the bathroom. Sometimes months at a time. Truly, it was a golden age.
Anyway, this was all well and good, but then one day a woman named Libby Zion died in a hospital due to the tired resident missing a diagnosis. (Personally, I think stupidity could account for that just as well as exhaustion.) Zion happened to be the daughter of a big cheese reporter and it came as a huge revelation to the world that you can’t perform competently while awake 35 hours in a row. But apparently, you can perform competently while awake 3O hours in a row.
It’s all very scientific.
The elevator seems to be conspiring against me to make me late for meeting Alyssa. I’m standing there for at least five minutes, hopping impatiently between my feet. I probably look like I have to pee. At some point, an elderly couple passes me, and the wife nudges her husband and says, “Look! It’s a little girl with a stethoscope.”
This is not the best start to the day.
In the elevator, I run into my lunch buddy from yesterday, Nina. The second she steps inside, I sneeze violently. I can’t help but notice she’s covered in cat hairs. They are stuck to the back of her white coat, almost like she’s grown a layer of fur.
“Hi, Jane!” she says. “Are you on call tonight too?”
“Uh huh,” I say. I squint at her, wondering how to phrase my next thought as delicately as possible. “Um, are you keeping your cat in your dorm room?”
“No,” Nina says, all wide-eyed innocence. “Of course not. That would be illegal.”
“Um,” I say again. “You’ve got cat hair on you.”
Nina looks down at her scrub top. I shake my head and do a spinning motion, so she wrenches her neck around to see the back of her coat. “Oh!”
“I won’t tell anyone,” I promise.
Nina lets out a breath. “Thanks, Jane. Honestly, I can’t make it through this year without little Valsalva.”
“Doesn’t your roommate mind though?” I ask. “I’ve got a single,” Nina says.
Seriously, some people have all the luck.
Naturally, Alyssa and Connie are already waiting in the resident lounge when I show up. And what they’re doing makes me ill: they’re comparing diamonds.
No wonder Alyssa and Connie act like they’re BFFs. They’re both engaged. They can bond by talking about the fabulous weddings they’re planning. Chicken or fish. Color schemes. Flowers. DJ vs. live band. The conversation topics are probably endless.
“Hi,” I say as I walk in.
Alyssa barely glances up at me. “The diamond belonged to his mother,” she’s saying. “But we changed the setting. And I wanted platinum, of course.”
“Of course!” Connie agrees. Of course.
They spend the next five minutes talking in diamond jargon while I sit on the couch across from them and twiddle my thumbs. I suspect we would have spent the next 3O hours talking about diamonds, except then Alyssa’s pager goes off. Her pager alert is the happy birthday song. Way to spoil every birthday I’ll ever have, Alyssa.
“It’s the ER with a new admission,” Alyssa reports. She looks at me. “You’re up, Jane.”
“Goody!” Did I say that out loud? Alyssa looks at me funny.
Alyssa whips out an index card and takes notes as she says “uh huh” over and over again into the phone. She hangs up a minute later, and she’s already glaring at me.
“I said you were up next,” she says. I just stare at her blankly.
She points her pen in my direction. “Why weren’t you writing down information about the patient?”
“Because…” I feel like this answer is too obvious, that there’s a trick that I’m missing. “They were talking to you on the phone. I couldn’t hear them. So I couldn’t write it down. That’s why.”
“And there’s no other way you could have gotten the information, huh?” Alyssa waves her index card in my face. “No other way you could think of?”
“Um,” I say. Did she really expect me to read her handwriting upside-down from three feet away?
“In the future,” Alyssa says, “I expect you to copy down the information as I’m writing it. That way, we don’t waste time.”
“Time that could be better spent discussing diamond ring settings?” I say. No, I don’t really say that. But I think it so vehemently that I’m
sure Alyssa must be able to somehow hear it.
My first admission of the day is a Russian gentleman named Mikhail Petrovich. He is having chest pain. At least, we think he is. Nobody has yet located an interpreter. But apparently, he’s clutching his chest and looking short of breath. So either he’s having chest pain or he’s just incredibly surprised.
This is my very first time in the ER, but it’s hard to miss since the first floor of the hospital is plastered with arrows directing me there. It’s apparently a busy day for the ER, because there are patients camped out in the hallway in stretchers, although many of them look like they’re “sleeping it off.” The stench of alcohol (not the rubbing kind) and old socks assaults my nostrils, and I start breathing through my mouth.
This place is a total pit.
As I’m slinking down the hallway, a guy lying on a stretcher grabs my elbow. I look down and see his fingernails are embedded with dirt. So are the creases on his face, actually.
“Are you a nurse?” he asks me. I shake my head. “No.”
He is undeterred by my response. “Do you work here?” “Yes,” I admit after a brief hesitation.
“Can I have some Percocet?” He offers me a hopeful smile.
“Let me find your nurse,” I mumble, despite the fact that I have absolutely no intention of doing so. I detach his hand from my arm and see he’s left behind a big dirty handprint on my fresh white coat. As I try to brush off the dirt, a stretcher nearly runs me down.
The high level of activity in the ER does not bode well for us, since we get our admissions from the ER. Busy ER = busy residents on call. So I better get a move on. I dodge a second stretcher rushing past me and attempt to locate Room 6, where Mr. Petrovich has taken residence.
I find Room 1 all right. Then Room 2. Then Room 3, 4, 5… and then the next room is Room 7. Is this some kind of sick joke?
I lift my eyes, scanning the room for someone who doesn’t look like they’re rushing to save someone’s life. A nurse pushes past me with a full bag of dark red blood. At least I hope it’s blood. Anyway, best to let her do her job.
My eyes finally settle on a familiar face: S*xy Surgeon! He’s talking to a young woman in scrubs. As I approach them, I notice the woman is cowering a bit, and I can tell why: S*xy Surgeon is screaming at her.
“You’re completely wasting my time, you realize that?” he snaps at her, his blue eyes flashing. “This is obviously a non-surgical abdomen. If
you’d bothered to get a CT before you called me, you’d have been able to figure that out on your own. I mean, is everyone who works down here completely incapable of practicing basic medicine?”
Holy crap. S*xy Surgeon is a complete asshole. Well, I guess that isn’t too huge a surprise.
I try to slink away, but it’s too late. He’s spotted me. I freeze, but apparently he’s not a T-Rex whose vision is based on movement.
“Medicine Intern!” he cries out. He actually looks pleased. The woman in scrubs takes this opportunity to slip away from him. She owes me big time. “What are you doing here?”
“An admission,” I mumble.
“Is this your first ER admission?” He grins at me. “That is really cute.”
“Thanks.” I roll my eyes. “Listen, you don’t… know where Room 6 is, do you?”
“Ah,” he says. “The elusive Room 6. Oh, yes.”
I can see a glint in his blue eyes. He’s enjoying toying with me like this. I wonder if he finds one medicine intern to pick on every year.
“You see that crash cart over there?” he says, pointing to the cart stocked with supplies in case of the inevitable ER Code Blue.
“Yes…”
As he extends his arm, I can see the muscles popping out. S*xy Surgeon’s got himself some nice biceps. But I’m not going to think about that. “Make a left at the crash cart, then it’s at the end of that hallway.”
“Thank you,” I say.
“My pleasure, Medicine Intern,” he says.
He may be cute, but if he calls me that one more time, I swear I’ll punch him in the face.
Nearly half an hour later, I am no closer to getting a history on Mr. Petrovich. Mr. Petrovich is a disheveled man in his sixties, with tufts of gray hair protruding from his skull and his chest. He keeps moaning and clutching his chest. Whenever I try to ask him a question, hoping he’s magically become proficient in English, he always answers the same way: “Nyet!”
I hate County Hospital.
I’m on the verge of tears when a man comes in with a big ID badge that says “Russian Interpreter” and declares his name to be Boris.
“Thank God you’re here,” I say.
“You may begin, Miss,” Boris says in heavily accented English.
I don’t bother to correct him by telling him that I’m Doctor McGill.
Instead, I say, “Can you ask him where he feels pain?”
There’s an exchange of Russian between Boris and my patient. I thought I asked a pretty simple question, but I swear they go back and forth like five times. “Nyet!” I hear Mr. Petrovich say.
“What did he say?” I ask.
“He said it’s on the left side of his chest.”
Five minutes of discussion for that answer? “And does it radiate into his arm?”
Another long exchange in Russian follows. At this rate, it’s going to take me five hours to get a history on this man.
Boris hesitates. “To be honest, it’s a little hard to understand him. I think he’s speaking an unusual dialect. Also, he’s mumbling a lot.”
Mr. Petrovich is probably difficult to understand because he’s edentulous, which means he has little to no teeth—where his teeth used to be, there are only gaping red holes. In medicine, we’ve got all sorts of fancy words for things that aren’t very pleasant to say in plain English:
Emesis: Puke Epistaxis: Nosebleed Stool: Poop
Dyschezia: Hurts to poop Hematochezia: Blood in poop
Boris and Mr. Petrovich converse for another few minutes while I stand there on the brink of tears. “Nyet!” I hear Mr. Petrovich say.
“What did he say?” I ask.
Boris at least has the decency to look apologetic. “He says his chest hurts.”
“Great.”
Hours awake: 5
Chance of quitting: 52%
