surfacing from the valley of the shadow of death

Can it really have been only six weeks since my last entry? Well, I've been at the Valley, our county hospital. I tend to think of the Valley in terms of dog years. In a month there, you'll probably work seven times as much as you would work anywhere else, and age seven times as fast.

One of our residents was recently called up to be a flight surgeon in Iraq. I couldn't help feeling a bit jealous when I heard the news: working in a war zone couldn't be nearly as hard as it was working at the Valley Medical Center.

Tell any other resident you're at the Valley and their sympathy will be boundless. "Oh, the Valley," they'll intone, suddenly an octave or so deeper. They'll sit back, nodding. The glint in their eye could be amusement, could be fear. Everyone will have a Valley story which doesn't need a hint of hyperbole to be fantastic: rounding on forty patients, beginning notes at 9am the previous day, getting fifteen traumas in the same call, six at a time, having four people die in one night. They speak of the Valley trifecta: incising a shooter's abscess, taking out a rectal foreign object, and draining butt puss. Residents have retrieved full sized flashlights, still vibrating sex toys, and a can of shaving cream from people's intestines. The Valley is a major trauma center where both the patients and the residents are traumatized.

About once a rotation, an intern will go to his car post call and realize that a patient who had been admitted that night had not been seen by a single doctor on rounds.

My favorite story is the story of the man who came in after an auto accident with a shattered pelvis and a cracked spleen (yes, soft organs can crack). He went to the operating room for an emergent splenectomy. Over the next week, he was in critical condition, requiring multiple chest tubes, central lines, and a ventilator. He kept losing blood, dropping his crit. Finally we threw up our hands and rescanned his belly, revealing the fact that he still had a spleen - only half of it had been taken out.

The Valley is simultaneously The House of God, A Comedy of Errors, and the Valley of Death. It is a place of 30 hour shifts and workdays where you go for 16 hours without eating, drinking or taking a piss. If we were patients, we would have IV fluids running and a foley catheter inserted for low urine output.

To be continued...