OK, it was not my first day, but it was my first Sunday on call. I had been a neurosurgical resident for about four days. The resident staff was only four. Being on call meant that I was in the hospital for twenty four hours straight, 8AM until 8AM. There was no scheduled surgery or diagnostic studies on Sundays, BUT Sunday was a big admission day for patients to have studies the next day or for surgery in the following days.
We had about twelve staff neurosurgeons to cover, both admissions and inpatients. We did not have to make rounds on all. The resident for each staff man did that on Sunday himself. The "on call" man was there for his own patients, new admissions, and emergencies. Aside from a few morning hours, he was the only resident there. The census usually ran about 50-70 patients in critical to all most well condition. Sundays off were precious. Unless you had active arterial bleeding, you did not ask your fellow residents to cover for you.
So there I was. New kid on the resident staff, first on call Sunday, and raring to go. Well, I didn't have to wait long. A little before noon, I got a call from Pappy. Some of you may remember Pappy from some other of my blogs. Suffice it to say that Pappy was the grand old man of southern neurosurgery. He was a bit behind the times at almost 80 years, but he was sharp as a pin. Anyway, he told me that his grandson had fallen at home and cut his knee. His daughter was bringing him in for me to sew up. He went into detail about how I was to do it, what antiseptic to use, and so forth. I had, by that time, considerable experience in suturing cuts as a student, intern, and general resident, but I assured him that it would be no problem. In the next breath, Pappy says that a dear friend of his has had a stroke (we took care of any/all strokes then) while in the hospital. Pappy said he liked to really be aggressive with strokes and would I go up to his room and do a stellate ganglion block on him. Well, a stellate ganglion block on a stroke is about as non-aggressive treatment for a stroke as it could get, but I wasn't about to give Pappy any flak about it. I also didn't tell him that I had never done a stellate ganglion block. I knew where to go look it up, and after all, I here to learn.
Sewing the kid up was a breeze. He was a great patient. I swung by the medical library and checked out stellate ganglion blocks, called the floor and told them what I needed, and went up to see the patient. He had been stroked since some time in the night before, so any treatment wasn't going to change things. Still and all, I did my first block on a stellate ganglion and got a nice block. This had taken me until about noon. Then things began to really pop.
Another staff man called to let me know that another stroke (fresh this time) was on his way in from a town not too far away. This staff man WAS aggressive. He told me to do an angiogram, and he would be in to see the patient. Well, I had been taught angiography as a neurosurgical intern, so I got busy in x-ray, did the study, and had it ready for the staff man when he arrived. Turns out this guy needed an operation and it was several hours before we got done with that. As I was finishing the dictation and the post-op orders on this man, I get an emergency call from the nurse on the neurosurgical floor. A patient of the professor's had gone bad. I rushed to the room, and indeed, the poor lady was brain dead. In those days, I didn't have a lot of experience with brain death, but I knew it when I saw it. We did a few cursory things for the family's benefit, and let nature run its course.
Now it was about 5PM, and I had yet to see any of the steady flow of admissions that had collected with the nurses on the floor. The grand total turned out to be TWENTY FOUR. Each of these patients had to be seen, orders written or checked, given a physical exam, and given a DETAILED neurological exam. Some were straightforward, while others were not. At 2 AM Monday morning, I got to my last workup of the day. I had been waking folks up since about 10 PM the night before, so I was surprised to cruise into this last patient's room at 2 AM only to find him sitting up in a chair reading the paper. I apologized for being so late, and he said, "Doesn't bother me a bit, doctor, I work nights anyway". After that, it was a relatively peaceful early morning. The next day, my resident mates were all amazed at what I had done the day before, but I think they were not sorry to not pick up the left overs.
Well, I thought if each Sunday on call was going to be this way, I might want to rethink my choice of specialty. It turns out that the first Sunday on call was the worst of my coming four years. They weren't all easy, but after that baptism of fire, I could handle most anything.
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