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Even
now, when I cannot attend a function because I am “on call”
many of my friends have no idea what I mean. Call nights are nights that
residents, interns, and medical students stay at the hospital after hours,
most often overnight, take care of any problems that arise, and admit
any patients requiring hospitalization. The most important thing about
call is how often you have to take it. Every third night? Every fourth
night? Every other? Of course, the more often, the more brutal. It takes
time for a body to heal after a forceful all night marathon. And, the
body has to function the next day like it wasn’t up all night. It’s
a fact of life, and everyone acts like it’s normal. And I cannot
imagine too many people liked it.
This was my first call night ever. I was a third year medical student, and this was my first rotation. Surgery. The first task is to find the call room, the small closet where there is a bed, a phone, and a computer for looking up labs and putting in orders. The next task is to pray you will be able to enjoy the bed that night. I went about my daily duties—holding room interviews, operating room pimping, rounding in the morning, rounding in the evening. Then, around five o’clock, I found the on call resident. Jill. She was beautiful and smart. She and I talked about how my third year was going, and she gave me advice and reassurance. We talked about career choices, and what it was like to be a woman and in general surgery. I helped her check labs. She asked me questions about my patients, so I could help her out. She taught me about managing patients on the floor. I was lucky that someone had time to fill in all the details I skimmed over on morning rounds. My team always rushed through rounds to get to the OR. Now I let the dam loose and asked the questions for which there was never time before. Then, around midnight, it was time for bed. I gave her my pager number. I tried to get some sleep. My tummy reminded me I had missed dinner. At 4:30 am, my beeper went off. I called the number on the miniature screen. The voice said, “Come to the trauma bay.” I went to the emergency room, and found my chief resident and the trauma surgeons in the CT scanner room, digging in someone’s belly. My chief was on home call and she was called in to operate on this patient. I didn’t yet understand why. A resident started shouting, “Her chest is full of blood. She shot herself in the chest. Her brachial artery is severed.” As vascular surgeons, of course we would be there to fix the artery, but before anyone had time to act, I saw her die on the table of the CT scanner. She had lost too much blood. I had been woken prematurely, been stripped from my bed to see someone perish at their own hands. This was my first dead body, and I had seen it living only moments ago. I was disoriented to time, place, and events of the calm night. I thought back to the pleasant conversation with Jill. Months had passed since we chatted about surgery as a career. They took the body away. I took the elevator to the ninth floor and started rounding. I tried to forget. The day went on as usual: rounding, conference, lectures, OR, pimping, retracting. My chief, my resident, and I were on afternoon rounds, admitting someone for an operation the next day. It was unusual for us all to be together. We were on a crowded elevator, riding up to see one last patient. The heavy silence hung like a theatre curtain. Many had scared looks on their faces. Many were tired. Three people in white coats stuck out in the crowd. An overhead page cut the curtain, and it landed at our feet. “STAT, vascular surgery, 11th floor intensive care unit.” Over and over the operator pounded us with the news. In the era of personal pagers, doctors are rarely paged overhead, as they are in soap operas. When they are, it means something is awry. My chief anticipated the emergency reflexively, and mumbled, “It is a ruptured triple A.” She knew that I had been at the hospital all night, and that I was tired. I did not have to come if I did not want to. She added that this is one of the true emergencies of vascular surgery, and to see one would be a rarity. The spotlight was now on me—do I look like the interested, tough student, or do I succumb to the yearning of my tired body and exhausted mind and crawl home? Really, my chief offered me the choice. I pushed the 11th floor button. We ran off the elevator, into someone who was there to guide us to the patient’s bed. A surgery resident told us that his patient was thought to have low blood pressure because he ruptured his abdominal aortic aneurysm, an AAA, a triple A. The aorta is the main blood-carrying vessel that distributes blood down to the abdomen and legs, and it was bleeding into his abdomen. The resident wheeled the patient down to the OR. We set up for the abdominal case, and prepared many, many retractors as it would be impossible to see in this 400 pound man’s belly, compounded with hemorrhage confusing the field. I quickly changed into scrubs. I scrubbed my hands quickly. My chief and attending were inside the belly when I ran into the OR. They had me help immediately, holding retraction. I used all of my strength, lifting, pulling, moving guts out of the way. They were digging down deep to get to the aorta. The kind resident helped me guide my retractions, as he was helping to retract, too. He also helped me start CPR. This man had lost too much blood. His heart started to give out—it was starved of oxygen. He began to have arrythmias—the anesthesia attending yelled “V-tach!” or was it “V-fib!”? I could barely hear for the noise in my head, and heart beating in my throat. Yells rang out in the OR for me to do a precordial thump. This is a quick thump to the chest to try to change the rhythm. I made a fist and banged on the chest. “Hit it harder!” I managed to muster all of my might and courage together and reared back and struck his chest unnaturally hard. It worked. Pretty good for a little girl. This went on for months, maybe even years, although the record showed it lasting ten minutes. I thumped, I started compressions, the resident took over compressions, the chief and attending continued to repair the hole in his aorta. Finally, it was over. He could not survive the significant blood loss. The surgeons stopped sewing on him. Anesthesia stopped breathing for him. I started to sob for him. My mask covered up my runny nose. My eye shield hid my red eyes. Eye contact was avoided anyway. The curtain of silence again hung over everyone who had witnessed the event. Nurses, doctors, residents, everyone, stopped. Slow motion began. Everyone slowly left. I was not sure where they were going. Where do you go after you have tried so hard to revive someone? What do you say when someone asks you how your day was? How do you gently explain why you are late for dinner? Everyone slowly left, and left me standing, all scrubbed up, in sterile form, with a retractor in my hand. I had all the time in the world to think. I thought about my birthday, almost one year earlier. I had been at the medical school helping to throw a good luck party for the first years, who had their first anatomy exam looming. Then I was going to study myself, and afterward my boyfriend was treating me to dinner. I came back home midmorning to retrieve my study materials. I listened to a message from my mom—she sounded worried. I called her back—my grandma died of a triple A, and abdominal aortic aneurysm. It was my first grandparent to go, my first funeral. It happened while we were studying cardiovascular pathology, affectionately known as Heart Week. When I returned from the painful funeral, I tried to reconnect as soon as possible with medical student life. The case of the week was a difficult one, and when the diagnosis was presented, it was a triple A. The coincidences were unbelievable and overwhelming. I left the room, crying on the sun-blessed balcony overlooking the hospital courtyard. I wept; death was too close to me and too far away. The cases we studied in pathology did not seem to be real live people; now I could only see flashes of life with my loved one in every slide of that presentation. Myboyfriend found me, held me on that hot September afternoon. I wanted no one else to see me, taking this case personally. I wanted to be a strong shield. My thoughts were disrupted when my chief resident walked back into the room, carrying the death certificate. She asked me to sew up the body so it could be presented in reasonable shape to the funeral home. She said I could use the practice. A scrub nurse came into the room to assist me, to hand me suture. One or two stitches into it, the kind resident slipped into the room and helped me do it faster. He did not want me to practice now; he wanted it to be over. I was glad he was there. Afterwards, the chief and the resident bid me farewell. I gathered my belongings from the call room. It was a sun-filled beautiful evening in September. The shadows were long, and the walk longer than usual. I seemed immune to traffic when crossing the four-lane road. I made sure no one was behind me. I bawled terrible screaming painful yelps the whole way home. I crawled into bed. I turned the phone off. I set my alarm for 4:30 a.m. During a quiet moment the next day, my chief acknowledged that I had seen a lot of death on my call day. She asked how I was. I said fine. Melissa Hilmes Department of Radiology
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