I wrote this a few weeks ago, and I meant to post it here, but never did. So here it is.
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There was a moment early on Saturday morning, just after a long night of admitting to the hospital, that summed up everything anyone needs to know about being a medical resident.
Friday was a busy call day, and we admitted our usual five patients early, with all five well tucked-in before 9:00 PM. #6 was on his way from another hospital, and since we had gone over five (the limit for an intern in one day), I would be admitting him without the help of mt intern. Our team had reached its limit of unassigned patients, though, and as long as no more of our own clinic patients showed up in the ER, I was golden.
Of course, I turned out to be far from golden. #6 didn’t arrive until around 11:00, and while I was writing up his note, I got three separate pages from the ER with #7, #8, and #9. We can usually expect to get up to six or seven this time of year, but nine? It was no surprise that all the calls came at once like that; the ER docs change shifts between 11:00 and midnight, and they really like to “dispo” patients during that time (doctor speak for “figure out how to make them not my problem anymore”). If they’re still trying to figure out whether a patients needs to be admitted or not by then, they’ll usually just call us.
All three sounded like weak admissions, and I was sure that I wouldn’t be admitting all three of them, but as I hung up the phone on that third call, I suddenly didn’t feel so bad that I had forgotten to bring my Call Pillow from home that morning, as the uniformly lousy hospital pillows would just not be a problem I’d have to deal with anytime soon. I had, fortunately, remembered to bring my supply of caffeine (in the form of a carton of Diet Pepsi); I slammed two of them along with a fistful of Cheez-Its from the office snack drawer and went into action.
When I hit the emergency room, I was in the zone. It was like the patients were moving in slow motion. #7, presented to me as a patient with right-sided numbness, had no such complaint when I saw her; it had resolved when her glucose came down from 800. Not only did I peg this as the source of her complaint, but I also immediately saw why it had happened, despite her stated compliance with what appeared to be a very good insulin regimen–she didn’t keep her insulin in the refrigerator. A little more insulin, a new prescription, and out the door.
#8 was a frequent flier who looked better than I had seen her any of the other times I had admitted her, and I insisted that she didn’t need a lumbar puncture, and that she’d perk right up with some IV fluids and a few hours’ sleep. Once again, out the door. Only #9, who appeared to have real abdominal pain related to a procedure the day before, managed to get over my brick wall, after I did my damndest to get her home.
It was 5:00 AM when I finally got everyone either in or out, and since we were rounding at 7:00, I could have just started my pre-rounds. However, I knew that soon I would be hallucinating, since I’d been awake since about this time the day before, so I instead retreated to the call room for a half-hour or so. I didn’t want to fall completely asleep, so I kept the television on; they were showing an infomercial starring Lindsay Wagner–the Bionic Woman herself–for something called the Sleep Number Bed. The idea of the product is that one can adjust the bed to one’s particular comfort zone, represented by a number between 0 and 100.
Lindsay went on and on about the amazing sleep one could get on this miraculous bed. She interviewed other happy customers; one young, attractive lawyer closed her eyes and purred dreamily about sinking into this mattress and how good it made her feel. Others talked of the incredible energy and stamina that one could have if one only had this stupendous adjustable mattress.
As they went on, I lay there on my decidedly non-adjustable mattress and realized what I was listening to–pornography. Pure, hard-core porn. It wasn’t even the sexual overtones of the tesimonies or the dreamy, post-coital expressions of the satisfied customers that provoked this reaction; the idea that one might have sex in a Sleep Number Bed never even entered my mind. To the chronically sleep-deprived resident who has been working for nearly 24 straight hours, their descriptions of hours and hours of refreshing, comfortable, uninterrupted sleep couldn’t have been more pornographic if Linsday had just gotten out of the shower when John Holmes stopped by to fix the cable.
Just like porn, it bypassed all critical filters and went straight to the pleasure center of my brain. Just like porn, it was completely idealized and unattainable. I felt dirty, like I should be watching this in a disgusting little booth somewhere, feeding in quarters by the fistful, or late at night on Cinemax with the volume turned down and my finger on the remote in case my parents should happen by. I felt that watching this infomercial would, without question, send me straight to Hell.
I lay there half-asleep for half an hour, letting this hedonistic advertisement fill my senses, before it was replaced with a less satisfying infomercial (for a weight-loss pill, I think) and I got up and started moving again. I thought later that other people might find my reaction to this infomercial odd, but those people don’t have my job.
Dr. J