4:55 AM, and I was dragging. My 12th day straight in the hospital, leaving a string of three call nights behind me with one left to go. Twenty patients to see before grand rounds at 7AM.

My knee has been hurting. I suspect it’s from the miles and miles I’ve been putting on my body 14 hours a day, 90 hours a week, running around the hospital. I’ve been taking the stairs everywhere in an attempt to remain in better shape, but this morning it was too much. No coffee yet and too little sleep. I gave in and took the elevator from the 3rd to the 11th floor.

I leaned back in exhaustion against the side of the elevator, eyes closed. It whirred into life, and I let the tug of gravity pull me to the ground. The elevator reached the top floor and *dinged* quietly. I stirred, mentally preparing to start rounds.

And then, the door made a few feeble attempts to open, and quit. Servos whined to a halt. I was stuck in the elevator.

Funny, how things can change. Any other time I would immediately panic. What if I have to go to the bathroom? What if the cable breaks? What if the call button doesn’t work? What if I can never get out?

Instead, pure, unabashed relief washed over me. I couldn’t work while trapped in the elevator.

Zac, why haven’t you finished rounds yet? The situation played out in my mind, There’s so much to do today! We have to get on it!

Sorry sir, I quietly replied, I’m physically trapped in the elevator on the 11th floor, there’s really not much I can do from here.

Well, I suppose you’ve got an excuse then. Take the day off.

I sat there for a few minutes, relishing the solitude. I planned out my entire day of rest, mapping out every delicious hour I would spend in each corner. Perhaps I’d take a nap right in the middle of the floor. I smiled. It was going to be a good day.

Then the elevator *dinged* softly again, and my hopes sank as I traveled back down. The door opened on the third floor. A tech stared at me in surprise, papers stuffed in my pockets, hair askew, sitting on the floor of the elevator.

“You alright, man?” he asked.

“Not really”, I responded. I stood up, knee hurting, as I limped off towards the stairs.

Surgery has been far worse than I expected. It’s actually not the patient care problems; my fears prior to this rotation were (mostly) unfounded. Somewhere in the last month I’ve realized that I am much more capable than I’ve suspected in the past.

Today alone I corrected severe electrolyte imbalances without needing to ask how, transfused a woman with approximately half of her normal blood volume, admitted 7 patients to my service with hardly any guidance from my upper level surgeons, and was told by the nurses on the surgical floor that they want to keep me to themselves, never to return to the ER.

That said, General Surgery is the most difficult, frustrating, and downright unpleasant rotation I have ever done.

The one substantial thing I failed to realize about surgeons – which, looking back on it, is a no brainer – is that they are always in the OR. This means they don’t respond to pages, and it is exceptionally difficult to get in touch with anybody. On top of this, they’re surgeons, and there is a machismo of “do it yourself” that pervades everything they do.

All that you have heard about resident work hour restrictions and duty compliance? Doesn’t apply to surgeons. I’ve worked at least 95 hours each week on service so far, with 32+ hours on call every night with no sleep. Official guidelines state 80 hours/week and 30 maximum on call. Oh, and 10 hours of time off between leaving the hospital and returning in the morning, which is laughable.

I don’t say this to garner pity, because I can hash it for a month. I say it for posterity, and for the sake of my patients who are getting poorer care than I want to give them. There is also no question in my mind that the surgeons are working even harder than I am, which is staggering.

My typical day starts at 5 AM. I need to round on 15 or more patients (our service is absurdly large and understaffed) in the space of 2 hours. This breaks down to approximately 7 minutes per person, most of whom I should spend about twice that much time on.

There are extremes in medicine, as there are in anything. Internal Medicine is known for rounding as a group for hours and hours at a time, spending upwards of 20 minutes on each patient to ensure that every i is dotted and t crossed. Attendings, senior residents, and interns all chat about patients in a formalized, clear fashion. There is a clear demarcation of who is responsible for what.

Our service, on the other hand, does not round at all. In fact, I’m lucky to talk to my senior surgeons for 10 minutes throughout the course of the day, which leaves me – an intern with 3 months of experience as a doctor – to essentially manage all of the problems that occur on the floor while they are operating.

From 7AM until 7PM or so, I respond to every call about the 40+ people on the surgical service. The pagers (I carry 2) go off every 10 minutes or so. Blood pressure too high. Blood pressure too low. Too much fluids. Too little fluids. Patient dying. Patient vomiting. At this point I really only call my upper levels about “patient dying”, as I figure this is a fairly important thing to pass along.

Today is the first day that I got home in time with 9 hours until I need to be back at work. I’ve got an hour to write before I go to sleep.

I suspect this is why surgeons don’t blog very much.

Tomorrow I start my general surgery month, on call at 5 in the morning. I’m nervous, for many reasons.

Apologies for the pity post. I’m allowed to do that once in a while, right? Cheer me up by forwarding this blog to your favorite friend and/or leave me a comment :)