Another July has arrived, bringing with it another fresh batch of young, impressionable, enthusiastic general surgery residents. According to statistics, most will end up doing fellowships and pursuing jobs with minimal call coverage such as "breast surgeons" or "minimally invasive surgeons". Whatever that means. But some die-hards will stick it out and take a job as a true general surgeon in a community hospital setting. Those that do are going to have weekends like my recent Fourth of July weekend; a weekend straight from hell.
Looking at the call schedule on the preceding Wednesday, I noticed that I was on trauma call at one hospital and ER call at another that weekend. I was also covering another busy general surgeon who was out of town on vacation. It was a confluence of circumstances conspiring simultaneously to create a perfect storm.
I went to sleep Thursday night at around 11. I woke at 5am and worked all day. At around 4pm the pager started and wouldn't stop, smoking from my hip. Level I trauma. Appendicitis. Diverticular bleed. I never went home Friday; operated all through the night, and then went straight from the OR to the floor so I could get rounds started. We had fifty (yes, five-oh) patients in both hospitals combined. I rounded for 7 hours on Saturday morning. New consults, new admits, pages of names on my list. I got home around 2:30pm, ate a Pizza pocket and mowed the front lawn. Your pager's going off again, my wife called out to me. Back to the hospital at 5pm. Free air, another level I trauma, a sick patient in the ICU, an incarcerated hernia. Again, I operated all through the night. At 5am on Sunday morning, I crashed out on the floor of my office for 45 minutes, not really sleeping, but not really conscious either. The pager went off again. I started rounds, struggling to concentrate, but getting through it. I started having paranoid thoughts that the Starbucks guy had given me decaf instead of the Americano I had ordered. I got home around 1pm. The backyard needed mowed. I can't stand asymmetry when it comes to back and front yard grass length. I mowed the back yard. What the hell are you doing?, my wife yelled out at me. I ate like a wild boar Sunday evening. I stuffed myself and ate and kept eating. I hadn't had a regular meal in almost 48 hours. Then, for some reason, I couldn't just go to sleep. I was wired and anxious and kept telling rambling incoherent stories. Finally, I dozed off at around 10pm. But the pager went off like clockwork every hour on the hour until my alarm went off at 5am on Monday. I showered and shaved for the first time in three days and went into the hospital to make some rounds. My partner took one look at me and told me to beat it after lunch. I got home around 3pm and crashed out for the night shortly thereafter.
Now this wasn't by any means a typical call weekend. It was an exceptional weekend; nonetheless it happens two or three times a year. You just have to suck it up. I made it through just fine. I took care of a lot of patients. I did some good work. No one was compromised by my lack of sleep. I couldn't do it every weekend, but every once in a while duty calls.
So you're a general surgery intern. You'll be working 80 hour weeks (and possibly less than 60 hrs if further reforms are implemented). Post call, you'll be eating a nutritious breakfast and reading the newspaper in the comforts of your own home by 8am, irrespective of any work that remains to be done on the patients you cared for over the night. The next day, you'll show up bright eyed and bushy tailed and completely clueless about what happened to the bowel obstruction you admitted while on call or the results of the CT scan that you ordered on the ER patient who had some vague LLQ abdominal pain. But hey, you'll be rested. You probably got a chance to read three chapters of Sabiston. You'll ace the inservice exam.... but will you be ready for the sort of weekend I just described when you're an attending surgeon?