Manning the Graveyard, Part 2

Alright - time for a bona fide confession: the real reason I went into urology has to do with my love affair with my bed.

As far a surgical subspecialties go, urology is considered one of the "lifestyle" specialties. The number of urologic emergencies doesn't fill up a hand: testicular torsion, bladder rupture, Fournier's gangrene. Most everything urological can wait until the morning. In general surgery, plastics, and orthopedic surgery, however, acute appendicitis, burns and trauma keep you up sleepless nights patrolling the emergency room.

I've always been inexplicably attracted to slumber. Even as a child I would linger in the arms of my mattress every morning, foregoing the joys of breakfast and (too often) dental hygeine to savor the last few minutes of recumbence before my school bus came. The dalliance blossomed into a full-blown affair in my senior year in college, when I realized that I was physically incapable of pulling an all-nighter (this after semesters where I would pull one a week). My last semester, in which I was probably clinically depressed, I would sleep for ten hours in a night, drag myself late to class, and then come home to collapse in my bed again. It was the only thing that gave me comfort, the blissful warmth underneath my blanket, the kind pressure of my blindfold keeping out the cruel light.

Which brings me to one fo the isolated joys of night float: every other day, when I'm not doing trauma, I can almost always count on a little bit of nap time. In-house call at the hospital is feast or famine. As I noted in my previous post, trauma nights can be non-stop action. On the odd day, so can non-trauma nights. Besides the hour or so of "work" that you invariably get in the form of post op checks, there will frequently be admissions or transfers from other hospitals (new patients that require a full history and physical examination, which can take up to an hour and a half).

When you're on call, patients are ticking time bombs. Take sixty patients, almost all with histories of cancer, heart disease, recent surgery - and something's going to happen. It's impossible to keep an eye on all the patients at one, so we rely heavily on nurses (who only have three to four patients) to be the first responder. Our pager is our dispatcher. On an easy night we get pages on the need for sleeping pills or antinausea medications. A lot of things can be handled safely by phone from our call room bed.

The calls we dread are for chest pain, altered mental status, and low urine output (which can be an early sign of internal bleeding and needs to be worked up). For these calls I drag myself out of bed and go see the patient. I order EKGs, labs, and give the patient the third degree about the details of his or her pain. What is it on a scale of 1 to 10? Does it radiate? Have you ever felt it before? What about on the night of January 17th, at 8 pm?

On a good night, though, these calls are few and far between and I can get hours of bonus premium nap time. Lately, it's been surprisingly difficult to fall asleep as my circadian rhythm has completely reset itself, and I lie on the uncomfortable plastic hospital mattress wishing for a fluffier pillow. But I can't complain. It's just nice to be horizontal.

About two or three times a night I'll get hunger pangs and set out on a quest for food. Nurses frequently bring in food, which is crucial as the cafeteria closes at seven. On several occasions when I've forgot my money I've staved off hunger by making a kind of buffet rounds from floor to floor, sampling gratis peanut brittle, nachos, leftover artichoke pizza.

In the past few days I've been spending time just shooting the shit with the nurses and my fellow residents. We've talked about the whether true love exists and pondered the roots of first impressions and racism. My co-intern likes to spend browsing the web for ways to spiff up his apartment. Another resident spent hours at looking at houses for sale on the North Atlantic coastline.

Downtime, however, doesn't always engender the healthiest of ruminations. During this month, I've had hours to gossip. Hours to bitch with the other residents about nurses and attendings. And, unfortunately, hours be depressed by all the bitching and ponder a career change.

Right now I'm sittin' in the boys club (the workroom that has turned into an informal hangout on call nights), listening 80s music while my co-intern and second year resident talk about the recent residency match. The conversation evolves into reminisces about medical school, then college. When they devolve into discussion about undergraduate girlfriends that got away, using phrases like "sizzling hot" and "man, that must've been tight," I feel my own lover tugging at my heart.

"Alright guys, see ya later." I go up to the call room. And in a short while, I'm in ecstasy.