When you are a young academic general surgeon, even the nights are sometimes good. A good on-call night unfolds something like this. You might have spent the day working in the operating room or in the clinic seeing patients. Your on-call typically begins at 5 p.m., although occasionally, a colleague may ask to sign out early. This call period will not end until 7 or 8 a.m. the next morning, and you will generally be responsible for taking care of any patients who are admitted during that period of time. You will, of course, work all through the next day in the clinic or the OR, whatever your normal schedule requires. That means a potential 36-hour shift without sleep. You’ve trained for it, like an elite athlete. You began doing these shifts in medical school. You don’t like it, but you know you will get through it.
If you are lucky, you will be able to drive home around the usual time and have supper with your spouse. Things will be quiet for a while, and you may fall into an uneasy sleep, your spouse beside you, the phone and pager near at hand. Almost invariably, if you are working at a busy hospital, a call will come from your senior resident. It always seems to be around 2 a.m. The resident will have seen and evaluated a patient for a possible surgical problem, such as acute appendicitis, and is now calling you to review the case and decide upon management.
At such times, you pray for clarity. If a general surgeon’s prayer were ever written, it would probably include the phrase, “Please make it obvious whether or not this patient needs an operation.”
You will decide to drive in and see the patient. If the resident has made a compelling case for surgery, you may even ask the resident to book the case with the OR – you can always cancel the booking when you get there.
You turn off the alarm clock so it won’t wake your spouse and dress in a hurry – nothing fancy. You grab your briefcase (ready at hand near the door), bolt down a cup of microwaved instant coffee, and hurtle down the dark streets at a speed nicely calculated to attract the attention of the cops.
You may or may not remember, in those very dark nights driving alone through the rural darkness, that a resident once told you, “Only prostitutes are out after midnight.” A woman driving alone, you may recall how many people told you to keep a gun in your car. You don’t own a gun. Cell phones haven’t even been invented yet.
So, you fear a breakdown, stranding you by the side of the road, far more than you fear being stopped for speeding. If you are stopped by the cops, your excuse that you are a doctor heading to the emergency room will generally get you off with a warning. But the whole process of being pulled over, showing your license and registration, and explaining the situation will slow you down. Take precious minutes.
The adrenaline is flowing by now, and you are hyper-alert.
You are driving to the compelling rhythm of songs by Steppenwolf, or maybe the Beach Boys, or Billy Joel. Singing along with the best lines, pounding the steering wheel with the beat. Building the adrenaline surge that will carry you through the rest of the night into the day.
You may or may not make it home again before the next day starts. Most nights, when the operation is done, you just go to your office and, if you are lucky, lie down on the floor and sleep for an hour or two. Then the next day begins.
As nights become years, and years become decades, and the decades pass, you take fewer and fewer night calls. Now, when you recall those nights—those nights full of frenetic energy, peril, and possibility—you recall them with fondness and wonder.
Carol Scott-Conner is a surgeon.
