It’s been 16 hours since I started my call shift. I’m sitting at the nurses station on 6 Surgical as one of them walks in carrying a take out container. Greek fries. She’s brought extra forks. I think of my upcoming trip to Cuba. Then she opens the lid. Irresistible smells waft upwards and I unwrap the plastic from around the cheap hospital fork. On-call calories don’t count, I tell myself, painfully aware of my diet these past eight months as I try to stay alive during my rotating internship. I haven’t cooked a real meal since December, in part because I haven’t been grocery shopping since Christmas. We sit there, 6 of us, and chow down, laughing about the state of US politics and wondering if Cuba will decide to boycott America right after America un-boycotted Cuba. 8 more hours.
Beep-beep-beep-beep. Fake enthusiasm draws laughter as I punch in the 5 digit call-back. It’s the stepdown unit, for a patient I don’t know, operated on by a surgeon I’ve never met. A mild fever. “Just want you to be aware!” Well shit. Being aware on a night shift is a curse. Being aware means being responsible. I leave my loaded fries and new friends and hit the stairwell. (Residents don’t use elevators, because elevators are slow, and because we eat Greek fries on call, and because deep down inside we know that on-call calories DO count).
Fevers can be nothing. Tylenol makes them go away. But fevers can also be canaries, subtle hints that badness is brewing. I check in on the patient. She’s recently had major surgery, and now has a fever. I note a heart rate of 98 – technically within the normal range (60-100) but only just. She says she’s fine, so I ask again, and she admits to some shortness of breath. Fevers can be nothing, but fevers can be blood infections, abscesses, pulmonary embolisms, or necrotizing fasciitis. Once I’m aware of a fever, I need enough evidence to calm my neuroticism before I squash it with Tylenol. No Tylenol, this time. I order an x-ray and labs and make a note to check them later. 7 more hours.
This is how the night will go. Chatter with nurses, picking at foods I tell patients to avoid, answering pages of vague significance, and meeting patients I have never met before, who’s lives the consulting surgeon has placed in my hands until 0700h. Read a chart, review a scan, order some blood work, hang some fluids. Don’t kill anyone.
Beep-beep-beep-beep. Less enthusiastically I pick up the receiver. The emergency department has a patient who I discharged yesterday. Ooops. I head downstairs and the wife assaults me with a venomous tongue. I take a deep breath. 6 more hours.
No one likes to wait. It’s been five minutes since I was paged, and this woman is irate. Her husband, she says, is dying. Gently, I explain he is not. Her husband, she says, has been mistreated. Kindly, I explain we do our best. I assess his surgical site. It is red and painful and oozing blood. Because we just did surgery on it. When you cut skin, it tends to get red and it tends to hurt and it tends to ooze blood. I sense my persona has shifted, like the tides shift with the apogee and perigee of the moon. I’m getting tired; enthusiasm is being replaced with sarcasm. I discharge the patient home, tell him the trochar site will heal, and thank the wife for her graciousness before walking away, rolling my eyes. It’s not that I don’t understand her, or him, or human nature. I get it. But rolling my eyes makes me feel better, if not a tad bit immature. I head back upstairs, knowing the fries won’t be the same cold and soggy.
It’s 0200h and there are 5 hours left. I realize that my Sunday post will now be a Monday post as I sit down at my laptop. The Tim’s closed at 11pm and there is no coffee here overnight. My Red Bull does the trick. I write a blog post about the only thing on my mind, which is the Greek fries. Cuba… shit, my abs…
I check the bloodwork of The Fever (yes, I know, I should call her Mrs Whatever-her-name-is, which for this blog post I would change to Mrs Whatever-her-name-sounds-like-but-isn’t, but I don’t remember her name). She’s sick. I call the nurse. I start fluid, antibiotics, and order a CT scan. I call the radiologist. I get up, obliged by my own philosophy more than any real occupational requirement to go see The Fever with my own two eyes. 4 more hours. When I come back, I’ll lay down. My eyes will close, but my mind will race. At some point, I might drift into a zone of semiconsciousness I can’t really describe, but which every resident knows.