pity this busy monster, manunkind

as i was saying, my month on trauma wasn't too bad--certainly far less painful than described by the ED interns who preceded me. i certainly wouldn't want to have been there for more than a month, but i can handle pretty much anything for a month. this brief return to the world of surgery (recall that i began my medical career as a surgical resident) confirmed a few things for me: first, being a surgeon is a fascinating job; you get to do all sorts of crazy stuff to people. there is no other job like it in the world. second, however engaging the job is, you really have to enjoy it, because it becomes their life. i worked 13+ hours a day (more on that later), with only 4 days off a month. i felt like i was always at work. contrast this with the 18 12hr shifts i work in the ED--that gives me 10 days off per month (that increases to 12 as a pgy-2)!

furthermore, as surgical residents become more senior, hours worked do not decrease--in fact, they may increase. granted they are in the OR more, meaning less humiliating grunt work, but regardless, there is little time in the surgeon's life for anything other than surgery. if one wants that great--i actually believe that type of single-mindedness makes for strong surgeons--but pity fool who thinks one can be a surgeon and have an active life outside the hospital; i should know, i tried.

enough proselytizing...i survived, and i actually enjoyed my month, but i am happy about my current situation as an EM resident.

back to those 13 hour days: as i said, it was very busy from 6am until 10-1030am with rounds, calling consults, ordering tests, etc. from 11am-1pm i would work on discharging people--dictations, prescriptions, etc--and then lunch time. the period from 2pm-5pm was generally very slow for the trauma service: generally, not a lot of traumas arrive in the ED during these hours (unless it's a weekend), imaging studies ordered earlier in the day are yet to be completed, and the discharges are frequently "waiting for a ride home."

what to do with these 3 hours? being an industrious lad, i decided to use it to build my fund of knowledge--that is to say, i set out to read, to learn more medicine during this time. where to read? well, sitting at the nurses station on the surgery floor was out of the questions, since one quickly learns that if nurses can physically see you, they will ask you to do something. since i prefer quiet, i opted to read in the call room (the place that one desperately tries to reach for a few hours of sleep when on-call). so, seminal ED articles in hand, i trudged off to the call room for some quality learning...

it wasn't long before the early mornings got the better of me and i drifted off to sleep. i was rudely awakened by my pager--another inane request from a nurse, no doubt, nothing i couldn't address quickly and still easily return to slumber.

i felt guilty about this for 2 days, until i realized that it was not the horrible transgression it initially appeared to be. as long as all my work was done, did it matter what i was doing? as far as patient care is concerned, i was still reachable by pager; whether i was sleeping or talking to a patient on another floor, or in radiology with an unstable new admit was irrelevant, as long as i promptly returned pages, and handled them appropriately. problem solved!

i think that i averaged 1.5-2hrs of sleep per afternoon, occasionally getting up to 3 ( i should also note the fact that my presence not being necessary for stretches up to 3 hours was a testament to the lowly nature of the work i was being asked to do)! what a difference that made.

i would emerge well rested at 5pm, and immediately set to work getting ready for evening sign-out, which took place at 630pm. my tasks for this 90 minute stretch included following-up any labs and/or imaging studies from the morning, updating the patient list, making sure labs were ordered for the next morning, and my favorite activity, making sure that the patients i had discharged had physically left the hospital.

i know this sounds ridiculous, but you would be surprised by how many people actively try not to leave once they have been discharged. regardless of the amount and ferocity of abuse they hurl upon you every day when you tell them they cannot go home that day, as soon as they are told that they can leave, there are suddenly 101 things keeping them in their room. no ride, no house keys, no cab/bus fare, no money in general, new symptoms (usually pain), fear of gang retribution, no clothes, "i'm just not ready yet", "you don't care about me", "you just need this room for someone else", etc. did i mention the fact that most of these people are degenerate alcoholics?

so i would rush around for those 90 minutes, tie-up loose ends, and arrive at evening sign-out refreshed and ready to go home.

a few weeks after the rotation ended and i was back in the ED, my program director approached me during a shift and informed me that i was well-liked by the trauma service and that a trauma attending even went as far as to tell her that i was the best ED intern they had had in a long time. i mention this not to inflate my ego, but rather to point out that stellar performance is not incompatible with afternoon napping.