Ninety-two hundred, part two

Remember when you were a kid and you complained to your parents, you would get the When I Was A Kid speech? The other day, I decided to do that to myself by remembering the most difficult bits of surgical internship. Kind of like Monty Python’s Four Yorkshiremen, only it’s me yammering at myself:

Get yer head out o’ yer arse, Doogal, and quit yer whinin’! You call that a tough week? When you were 29, you were putting in 100 hour weeks, you snivellin’ excuse for a doctor!

Without further ado, here’s more pain.

My life revolved around food and sleep. Sex? What’s that? Sex is a luxury made possible by adequate food and sleep. And that lying Samuel Shem, author of House of God, in which an intern couldn’t set an IV or draw an arterial blood gas without getting laid by some hypersexual nursing student into tourniquet bondage, if Samuel Shem shows his face in MY hospital, I’ll . . .

You’ll miss it, asshole, because you’ll be setting an IV, or drawing an ABG, or doing a pre-op, or placing a Foley catheter, or grabbing an hour of sleep.

Food and sleep, sleep and food. My body did the work. My mind dreamed of sleep and food.

FOOD

The LA County Hospital Health Shake 

1 can of Ensure (chocolate is best)
crushed ice

Pour Ensure over ice. Stir. Drink as rapidly as possible, swallowing it before you have a chance to taste it.

Our cafeteria stayed open for dinner from 4:30 PM to 7:00 PM. God help you if you showed up at 7:01. The food was starchy, industrial, but it filled the void until morning. If you missed dinner, you ate the food the wards kept handy for the patients: Ensure, graham crackers, tapioca pudding, jello, flan (yum . . . the best. But every other poor bastard on call thought so, too, so good luck finding any), Saltines.

LA County Hospital Smores

graham crackers
tapioca pudding

Put a big dollop of tapioca between two graham crackers. Eat it, all the while imagining chocolate.

The residents and med students had it great. The residents would send the med students out for food at the local taquerias, which were top notch. The local Chinese and Thai fast food joints were atrocious, but you could only eat so many carnitas burritos. During my general surgery rotations in internship, I didn’t get in on these little feasts, not once.

SLEEP

On 9200, we had a small ward behind the nursing station jam-packed with cots. If I was caught up on my work, I could duck into this room and grab a bed. Then I would lie down and wonder when my pager would go off. Would it sound before I dropped off? A minute after? An hour, two?

Once, I slept until morning, three-and-a-half blessed hours. I woke up feeling certain I would find my ward packed with unprocessed patients, my resident breathing down my neck. But no: we had had a quiet night. The knife-and-gun club had, for once, called a truce.

Way too often, I would dream about my beeper going off. Then I would wake up, haul myself off the cot, and stagger out to the nursing station, where three slack-jawed Cosmo-slurping nurses would look up in unison. One would say — annoyed because, you know, I’m interrupting them — “What? We didn’t call you. Go back to bed.”

WORK

A blur.

I remember the smell of spilled urine in our lab area, the broken capillary tubes (we spun our own hematocrits), a sticky benchtop no one wanted to clean. I would like to think I wore gloves at all times. It’s an appealing thought.

I remember one morning at attending rounds when suddenly I was the center of attention. A resident had put up an X-ray showing a length of rebar within some poor guy’s abdomen. I had just seen a similar injury two or three weeks earlier. Rather than keep my mouth shut (which is what a good intern is supposed to do — speak only when spoken to), I’d blurted, “Shit! Another rebar!”

Everyone seemed to think this was hilarious, even the attending. My resident grinned at me. Somehow, I’d done good.

I remember pushing through the fatigue. Getting the job done.

I remember one of those slack-jawed nurses looking at me, shaking her head. “You sutured that kid’s leg without any local?” she said. “That’s cold-blooded, man.”

I wanted to shake her. What are you talking about? What do you know? Were you there? Did you watch me suturing that kid? But then I realized, I couldn’t remember whether I had given the kid a shot of local or not. Then my blood ran cold.

***

Like I’ve said before, it wasn’t about learning. It was never about learning. We were taught nothing about patient assessment. What pearls we gathered were those that were thrown to the residents and happened to roll our way.

It was about getting the job done. I suppose that’s what we learned: we had it in us to get the job done. Sleep-deprived and nurtured on a diet of starch-coated starch, several hours past cranky, we could still function like good little robots and work through our To Do lists.

Becoming a doctor? That’s what residency was for. As interns, we were paying our dues.

D.