Black Clouds

There is a joke around the hospital that I am a black cloud. Basically I have been on call a ton in the past few weeks (6 nights in 2 weeks) and every one of those nights has been full of disasters. The chief residents (who take call from home) have picked up on it and seem less excited to have me on call with them as they will inevitably have to come in and take a patient to the OR with me.

Let me preserve my dignity by saying I didn't in any way cause these problems but they all arose while I was the only "surgeon" in the hospital (someday I will be able to call myself a surgeon without using quotes). Several of the patients were transferred in from smaller hospitals in the middle of the night and were incredibly sick. Another several presented to our emergency department and a few were already in the hospital being treated by other services.

The common thread is that they all (yes, every last one) required emergency surgery. That is exceedingly uncommon. We usually get consults for all sorts of non-operative issues, and a few that need surgery. Last night was my last night on call for a while. A patient we have been taking care of for a long time started hemorrhaging rapidly from somewhere in the intestines. I was transfusing the patient as fast as the blood bank could send blood up and he managed to pull through the night. I explained to the family how grim the prognosis is in an effort to get them to reassess how far they want us to go in what seems like futile care. In the end, the decision is theirs, but I feel a moral obligation to be clear about how serious a situation is so they can make educated decisions.

The good news is that most of the patients have done very well and I have gained all sorts of experience in resuscitating patients, counseling families and quickly delegating and getting things done. I seem to have earned the respect of the staff surgeons which is always a good thing. The bad news is that I am exhausted. I have been basically pulling an all-nighter every other night for 2 weeks without a single day off in several weeks.

The even better news is that this will quickly be remedied as I fly to Puerto Vallarta in the morning for a week of bliss. My pager is being left behind, my phone is off, I won't be checking email. I will be all there...resting...having fun.... Adios!