On Call, Cardiac Surgery, and Cupid
The article by Dr. Pauline Chen in the New York Times on trainee physicians work hours prompted my memory of my own call extravaganza.
As an intern on the heart surgery service I shared the workload with two other interns, David and Rick (all names have been changed). The service was a busy one, one of the busiest in the city. That Monday morning in 1987, David signed out to us at 6am before leaving for a weeklong vacation. Rick and I surveyed the to-do list of tasks for the day; he agreed to be based in the post-op cardiac unit and I went downstairs to assist in the OR.
A couple of hours later, I was completely focused on the task in hand, holding the cannula steady while the attending surgeon, Dr. Harry Brown, tied the purse-string suture around it, the tube to divert the blood while the patient was on cardiopulmonary bypass. A voice behind me said, “Pump’s primed,” the signal that bypass could begin. The RN first assistant harvested vein from the patient’s lower leg, before being sutured to the coronary vessels to circumvent the blockage. I heard the door open and Gary, the fellow in heart surgery (and most senior trainee on the unit), entered the room. From behind his mask, he uttered two words, “Rick’s bolted.”
Both Dr. Brown and I looked up, the words percolating through our respective cortices. “What do you mean ‘bolted’?” enquired Harry. The room was silent otherwise apart for the rhythmic rumble of the bypass machine. Gary answered, “Bolted, gone, left the building, don’t know if he’s coming back.” He nodded to me, “Scrub out, get upstairs and get the scut done.”
Thoughts were racing though my brain as I computed this bombshell of information— Rick gone, David gone. That left only one intern on the service — me, until David returned the following Monday. I’d be able to leave the hospital the evening he came back. Mental arithmetic led to the hard-to-grasp answer, I would be on call for the next 178 consecutive hours. The thought that came foremost to my mind was — I don’t have enough clean underwear with me to last for a week. I’ll have to call home for more.
I’d been in a similar underwear situation before, during my first internship in Glasgow, Scotland in 1981. I should explain that I completed four years of surgery training in Scotland and a two-year fellowship in surgical oncology in Buffalo, NY before commencing more residency training in the US to fulfill requirements of the American Board of Surgery. I was an intern with six years of surgery experience. One of my fellow interns in Glasgow called in “sick” with a migraine one morning when I was post-call. Calling in sick is not generally done in medicine unless one is actually hospitalized or on a gurney being wheeled to the OR as a patient. I could imagine my classmate’s illness though; I knew full well he’d been at the “Roob” the night before. The Rubaiyat was a hostelry on Byres Road, it’s dark interior lined by murals depicting gilded verses from the poem by Omar Khayyam. Migraine or hangover I wondered, knowing his liking for Scotch with a chaser.
Harry Brown looked at me from under his bushy eyebrows, his angular shoulders shrugged, “Off you go then.” I peeled off my gown and gloves, the RNFA moving into my position across the table. Upstairs I set to it, changing central lines, pulling pacing wires, treating arrhythmias, performing history and physicals on the incoming patients for the following day — hopping around from task to task like the scut bunny I was. One patient had dehisced his median sternotomy, the midline incision the length of his sternum, a rare complication of cardiac surgery. He required a dressing change, an intricate task, my hands moving swiftly in and out of the wound as the edges of the sternum opened and closed like a clamshell with each breath.
The following morning, as I contemplated my next night on call, an intern from another service came up to me in the unit while I was making notes in the chart. Matt looked at me with his soft puppy-like eyes, “ I’ll take call with you every other night.” The reason for his largesse — Matt had fallen in love with Mary Beth, one of the night nurses in the cardiac unit. This way he could be near to her.
And so we made it through the week, Matt and I. When David returned I recounted the story. He stroked his russet-colored beard beneath his sunburned cheeks, listening. He just shook his head.
I wonder how it would have been if Matt’s heart had not been pierced by Cupid’s arrow, if I’d been on call the entire week? And what became of everyone? I hear you ask. Matt and Mary Beth married. David and Matt went on to be plastic surgeons. And Rick? I kept thinking we would hear from him, a note, a call, letting us know what happened. But not a word ever came. Every now and then, when I’m rearranging my underwear drawer, I think of him. I hope he’s recovered and has found his niche.
Tags: call schedules, cardiac surgery, cardiopulmonary bypass, Cupid, Cupid's arrows, heart surgery, Pauline Chen MD, resident physician work hours, resident physicians