Vol 96: The resident on call
I once worked at a prestigious hospital in New York and there were many days when I tracked how many times I walked up and down the stairs from the residents’ lounge to various parts of the hospital. Sometimes I timed myself. The emergency room, the in-patient floors and the operating theater were all close enough to get to in less than 10 minutes, give or take a minute or two. This of course was dependent upon the time of day since the earlier my shift, the faster the cadence of my gait - one of the facts I accidentally discovered through that exercise of timing myself.
But then there were times in communion with the chaos of the day that it was absolutely impossible to tell how many trips I made. On those days I was the resident on call and I simply wasn’t paying attention.
On one such night, the rest of my team had left to be with family and mentally decompress. Visiting hours were now over and throughout the hospital, the skeleton crew took command. The weather was frigid and the roads were icy so I knew it would be a busy Friday night. I made my way to our lounge to get some hot chocolate. Waiting for the elevator often took too long and at a busy hospital, every second counted. So, I took the stairs. Apart from the quick access it provided, the stairwell also offered a hollow quiet that allowed me to strategize how to effectively conquer the night. I had a tedious list of things to do and time never seemed to be on my side.
I made it to the residents’ lounge in four minutes but there weren’t any more hot chocolate pods. Just a mix of coffee pods alongside a platter of picked-over bagels, donuts and warm fruit. During my stairwell strategy rumination, I was prepared to settle for tea if there was no more hot chocolate, but they didn’t even have that. Luckily, I planned ahead and grabbed my wallet from my locker beforehand but I forgot my jacket. So, I carefully walked across the street to the convenience store with only my lab coat, scrubs and a tool belt of pagers on my waist. Unsurprisingly, neither of them offered any safeguard against the winter’s freeze.
As soon as I entered the store, the owner yelled ‘BAHAMAS’. He was an older gentleman from the Middle East and he was always smiling. ‘Good to see you my friend’ he’d say, loudly enough for everyone in the store to hear. He was an amazing person, full of joy and well situated across from a place where exhaustion, pain and heartache were all too commonplace.
My teeth were still chattering from the cold but I told the gentleman to tell his wife that the chicken salad she made the day prior was amazing. His easy smile grew into a grateful grin. I purchased my hot chocolate and a health bar that I tucked into my pocket and made my way back to the hospital. Twenty minutes had past and I’d already wasted too much time. A crowd of people was waiting on the elevator so up the stairs I went.
On my way to the lounge, I saw one of the surgery interns and based on her disheveled appearance, she was already overwhelmed. She’d come off a long stint in the operating theater and now she had to check on all of her inpatients. She stopped me to ask if I could consult on one of them; a patient with an infected heel ulceration. Then, in the same breath, she asked if there was any more coffee in the lounge. I nodded yes to the coffee and told her that I’d see the patient within the hour. I got to the lounge, sat down and before I could take a sip, my pager went off. This evening’s veritable maelstrom of events was now beating at my doorstep.
My specialty is podiatry (foot and ankle medicine and surgery) but I was on my orthopedics rotation at a level one trauma center and that night a young man was brought in via ambulance following a motorcycle accident. I made my way down to the emergency room in six minutes.
The victim was around my age and height and practically every bone in his body was broken. His leg and hip bones were crushed into multiple fragments, splintered like a kitchen glass that fell onto a hard tile floor and shattered into a hundred pieces. He was in excruciating pain unsubdued by the cocktail of narcotics being pumped into him. His screams were so deafening that it pierced even the most stoic bystander as he cried for his mother and begged us not to let him die.
From the best we could make out in between screams of pain, he lost control of his motorcycle. His hand and wrist snapped as his bike flung up into the air. He hit the ground, back first, and panicked as he heard something crack. Then the unthinkable occurred, his bike landed on top of him. Fortunately, the patient had no past medical or surgical history, he wasn’t on any medication and he had no known drug or food allergies.
A full body CT-scan was performed. According to the radiologist, it was one of the worst he’d ever seen in his entire career. The patient had perforated multiple organs and was bleeding internally meaning general surgery was required not only to stabilize his fractures but to stop the bleeding that threatened his life.
All of my senior residents were called to assist. The patient was placed into a harness and once stabilized he was signed over to the general surgery team. One of the ER nurses shook her head and sighed. ‘I hate motorcycles’ she said and her abrupt outburst was sandwiched between expletives. By then, my pager was beeping. I had another consult.
For the rest of my shift, I scrambled from one crisis to the next running back and forth consulting on patients already admitted to the hospital and those in the ER. Fortunately, none were as harrowing as the motorcycle injury patient. But my mind constantly wavered back to the young man, a stranger, crushed by something that once brought him so much joy. I imagined how excited he must have been to purchase it and the freedom he felt from driving it. I thought that day must have seemed so trivial and far removed now on this day as he fought to stay amongst the living. Then, I moved on to the next patient. There was absolutely nothing that I could do for him but my other patients needed me and deserved my undivided attention.
I finally got around to evaluating the surgery intern’s patient and significant sclerotic changes to the heel region were observed on his lateral foot X-rays. He was spiking a fever, his white blood count was grossly elevated and his wound probed to bone, which were symptoms pathognomonic for a bone infection. His vascular status was intact so I added him to our OR schedule for the following afternoon and updated my on-call attending physician.
All those consultations had to be interspersed between seeing our own inhouse patients – following up on blood work that I’d ordered earlier that day, reviewing patient vitals, changing wound dressings and adjusting medication dosages. By the time morning broke, I’d had less than an hour of sleep. As we rounded on patients together, I updated my team as to what happened during the course of the night and then, alone, I made my way back to the lounge relieved that no one died on my watch.
My hot chocolate was still waiting for me where I left it but, now cold, it had lost all appeal. I grabbed my health bar and ate it in between yawns. It was the first meal I’d eaten in 17 hours. It took me 11 minutes to get from the lounge to the lobby and I stopped by the ER before I went home to check on my motorcycle patient. He’d already been taken to the OR but the nurse was skeptical if he’d survive. I never asked about him after that.
I’ve had many on-call nights but I thought about this one in particular because of the exponential rise in motorcycle related deaths in The Bahamas this year - four just this past week. According to police, none of the victims was wearing a helmet.
Even now, I wouldn’t go as far as the ER nurse and say that I hate motorcycles but I’ve seen the damage they can inflict and always dissuade my family from getting on one. And for those who will, no matter how stern the warning and never imagining that they could be the next victim, I implore them to wear protective gear as uncool as it may be. There’s nothing cool about a broken bone or a perforated kidney. There’s nothing cool about the pain inflicted from being tossed off a motorbike while speeding at 50 miles per hour. And there’s nothing you can say to console a mother who has to watch her son’s brains being scooped up from the road.
I pray for all the victims and their loved ones involved in these recent accidents. And I salute the residents on call challenged daily with the awesome responsibility of rendering care to these victims during their darkest hour, often with very little food, sleep or praise, day after day after day.
This is The KDK Report.
