Manning the Graveyard

In its natural rhythm, internship is more like medical school than like being in the "real world." Though I'm on the path to being a surgeon now, I'm not yet a urologic surgeon. My curriculum this first year is designed to give me exposure to a broad cross section of surgery - so I don't only do urology: I do cardiac surgery, transplant, trauma, plastics and pediatrics.

As the month turns, I progress around the hospital merry go round. This is gratifying in that you never get bored and are constantly learning new techniques, but also frustrating in that you are constantly learning new techniques and never master anything. Each month you work with different people with different expectations and different ways of doing things.

This month, I'm on "The Float". Night float is a child of the new eighty-hour work week restrictions. In order to reduce the amount of call nights "in house", I become the hospital vampire- at-hand, working from 5pm to 7am. I appreciate it because it allows me to actually see daylight (versus coming in at 5AM and leaving at 7PM), and because its hours are long but regular.


The hospital at night is quiet, which is wondeful for your sense of control. The escalator stops running, and when you walk around, instead of anxious family members waiting around, you see exhausted family members taking a blessed sleep on couches in waiting rooms off the hallway. You tiptoe to see crashing patients. At times, I even have time to breathe, and to create and write in blogs (obviously). All services run on skeleton crews so the hallways are less like Midtown Manhattan and more like rural Kansas (with the occasional floor waxing machines standing in for the heavy machinery). In general, night nurses are more relaxed and happier than their daytime counterparts, who get the brunt of all of the "work" assigned in the mornings. But night float comes with its own frustrations.

Instead of taking care of perhaps a dozen patients on one service, I cover up to four different services with anywhere from 20 to 50 patients. The relative easiness or difficulty of my day...er...night, then, depends on the crucial "signout" that I get from each individual team. They run down the list, telling me what the key points of each patient's course is. They give me my marching orders - checking labs, doing postoperative checks, getting consent for operations the next day. "Scutwork" galore (for a surgical intern, scutwork is anything not involving the OR or a bedside procedure).

Condensing a sometimes lengthy hospital course into a two or three line blurb is difficult, or at least it's difficult to do so in a way that ensures "continuity of care" (meaning, does the doctor who is treating the patient know what happened before so 1. he doesn't have to reinvent the wheel and 2. he can come up with a unifying diagnosis to explain problems encountered in the context of the patients previous illness).

Surgeons aspire to anticipation. In the operating room you want to foresee the next move so you can get your instrument ready. Like a chess player, when you're seeing a patient for the first time you want to see what could potentially go wrong and ge the tests and procedures you need to detect these possible/probable complications before they happen. The same is true for signout - but it's almost impossible to do in a timely fashion. Invariably you get a call about a patient and you have to pore over his/her chart to see what happens. If you're lucky, you actually have time to do this.

Every other night, however, I cover trauma. On a Monday night, when our ICU is full so traumas are diverted to the poor saps down the road, this doesn't mean too much. On a rainy Friday night with hydroplaning cars and payday-flush lushes coming home from bars at closing time, this can mean that I spend the entire night wearing lead to sheild myself from the obligatory X-rays after traumas and rolling car crash victims to the CT scanner.

Being on night shift means I get to babysit all of the DUIs who get smashed up after closing time. While traumas with bona fide injuries get a hospital bed, a lot of people who are merely "altered" because of alcohol consumption chill out on a gurney in the emergency room hallway until they "metabolize" (ER sober up).

Tonight I took care of a pair of twentysomethings who crashed into a telephone pole two blocks after leaving a bar. They were definitely borderline traumas (meaning that they could have probably just walked into the emergency department to be treated without a trauma activation). They were alert and knew their names; in fact, they knew enough not to want to try to give their names. "Why do you want to know? Why don't you just ask the police officer?"

"Because it's important for me to know that YOU know your names, the date, and where you are as part of the standard trauma workup that everyone gets."

You don't expect pushback from people you're trying to help. Sixtynine, Leo (every patient gets a predetermined trauma name based on when they come in), the driver in the accident, squealed and cursed when the nurse tried to get his temperature with an ear thermometer. When we asked him where he felt pain, he sneered. "The only pain I feel is from that needle you put in my arm."

As part of every high impact trauma, we do a quick and dirty ultrasound of the abdomen to identify fluid that is suspicious for blood or intestinal damage. As I squirted the jelly for the ultrasound probe on the 22 year old passenter he squirmed and giggled as if it were some kinky truth or dare challenge. Is that my baby? he joked, squinting at the screen.

I guess this would've seemed funny if this hadn't been a trauma situation, if I weren't thinking at the time that he and his drunk driving buddy were damn lucky not to have hit into a person instead of a pole. Instead, I kept going, moving the probe to his bladder to visualize his pelvis. He almost went into convulsions.

"Aaah! Stop that! I've gotta pee."

And a little devil on my shoulder made me say, "Then we're probably going to have to put a catheter in you because we can't let you sit up until we've made sure your back is okay."

The expression on his face when comprehension dawned through his alcoholic daze was priceless.

I relented and let him pee into a urinal, but as we were wrapping up the trauma and sending him to the CT scanner I told the trauma nurse shook her head at me. "Ilene, you're really starting to scare me."

I shrugged. I guess I was cranky at having to do this at 4 in the morning when I had better things to do. I guess I really did want to teach him a lesson so he didn't come back in a couple of years as part of a DWI involving another car.

And come on, I thought, I am going to be a urologist.