What was it like when you......


OK, I guess its the popularity of Grey's Anatomy or something. Maybe just a long standing morbid curiosity that no one would dare to ask about before, but now that I am "older" its safe....What was it like...when you were a resident? Were you people really that crazy? that irreverent? that promiscious?

Keep in mind, please, that I have never seen Grey's Anatomy. Or Scrubs. The last medical show I watched was St. Elsewhere. Yes, that dates me some, but hey, I finished med school in 1987. Almost 20 years ago. God damn. I am getting old.

People ask: "did ya'll really sleep together and all that?" Define "sleep together." I trained in the days of shared call rooms. Not by choice, like it is now, but by necessity. Not on every rotation, but on most. One call room: 3 residents, 2 med students, 2 bunk beds. You do the math. And the kicker is: we didn't think a thing about it. I remember calling my mom one night from the call room at the "Sugar Shack" (Diabetes Hospital) and she heard my resident snoring in the background:

"Who is that?"
"Just Ron, Mom."
"Who is Ron? I thought you were on call?"
"I am, Mom. He is my resident."
"That black boy??!!! For God's sake, don't breathe a word of this to your daddy; it'd kill him for sure."

Never mind that Ron was brilliant, and one of the nicest gentlemen I ever met. I didn't have the heart to tell her that there were 2 other guys in there as well.

I guess if you were going to have sex you would have had to find some privacy somewhere else. Any many people did. The parking deck was really popular (still is, I hear)--unfortunately, now there are security cameras. I did hear of one couple who were going at it in a car--unfortunately her very long bond hair was caught in and sticking out of the door. The security guards thought there was a body hidden in that car, so they assembled what amounted to a SWAT team to check it out--giving new meaning to the term coitus interruptus. Of course, at Children's where I did the majority of my call we did have private call rooms. I think that made it worse, because suddenly there was the opportunity to be bad. And many people were. Bad. Or good, depending on what you were judging. And judging from some of the night noises there were some really---good---folks having a great time. They did put locks on the doors finally, after several of us complained about surgery residents showing up in our beds uninvited...of course, the philosophy then was "well, why were you in bed--I'm sure there was work you could be doing..."

I woke up one night in our NICU call room with the respiratory therapist in bed snuggling up against me--he had to give me a blood gas report on my patient and get orders to make the ventillator changes. Good old Tom just snuggled in and made himself at home until I woke up; he then flashed a laryngoscope in my face so I could read the blood gas slip and whispered "whadda ya want to do now, baby?" to which I replied "go up on the rate to 40 and on the O2 to 60%--check another gas in 30 minutes" and promptly went back to sleep. He got up and made the changes I ordered. Did I feel threatened or violated? Hell no, I was glad he didn't turn on the overhead and wake up my upper level resident, who was in the bunk above me, going through a divorce, and was testy as hell.

We trained before the days of work hour restrictions. I got my first day off after 4 straight months--every day, every weekend, every 4th night on call. And they had to make me take that day. I was scared not to come in--afraid my attendings would think I was a slacker; afraid my patients would miss me or somehow not do as well without me there to supervise their care. Not that I, as an intern, was some brilliant doc-in-training. I was simply there. You see, we knew our patients. We were their doctors, and if they crashed, even if it was after after 5 pm, we stayed with them. We knew if they were allergic to a med; we knew all their weights. We knew if they liked purple or red tylenol and what foods would make them puke in protest. We made rounds on them every day--not just when we were on call for the weekend. If they had a great day we celebrated. If they crashed we stuck them with needles and tubes and found out what was wrong--and sometimes cried with their parents when it all just seemed to be too much. There was none of this "checking out" after 24 hours. I once had an attending call me when I was on vacation because one of my patients had been hiding his new meds in a drawer since I left--I hadn't told him about them and "he just wanted to be sure it was ok with me". Is there any higher compliment?

We worked hard--they told us the first day that if we were married the odds were against us--I don't know how many of us actually made it through still married to the same person we started with. I know I didn't. We played hard when we weren't working, but that was so very seldom that we also played hard while we were working. And we developed some really sick senses of humor. Face it,we were a weird bunch. We went by our nick names, to the point that even the hospital operators used them: "Paging Dr. Rabbit. Dr. Jack Rabbit, Please report to the emergency room." It cracked us up. We had call every 3 to 4 nights--some of us more if we were big moonlighters. Our work was our life. And WE LIKED IT THAT WAY! It was what made us special; convinced us that we made a difference; gave us the guts to stick large tubes and needles into tiny bodies and hope--no, demand that they got better. If I hadn't had to make hard RIGHT decisions when I was too tired to think I don't know if I ever would have been able to trust myself to make decisions when I was awake and able to think too much.

We became callous, and jaded. But not with our patients: with the system, the parents, the world at large. We saw unimaginable horrors, and true miracles. I will probably share some of these stories in the future if for no other reason than to keep them alive in my heart. We lived through so much--births, deaths, and every high and low in between. We made a difference to a lot of kids; and they made a difference to us.

Were we like the TV residents? I don't know--I'd have to watch. But probably yes, just MORE so. Our system had very few restrictions on how we lived and worked. Is it better now with the current resident work hour restrictions? I don't know. Interestingly, a recent poll by the ACGME (the folks who came up with the work hour restrictions) reveals that the residents themselves feel that the quality of care they give has decreased as well as the the continuity of care. They also felt that while fewer errors were occuring due to fatigue, more errors are being made now as a result of continuity of care issues, and that there is a definite "shift work" mentality. The doctors in training now definitely have a life outside of the hospital--which may be healthier for them, but they don't report that they sleep any more than we did--they are expected to actually participate in life outside of the hospital--something we didn't do. I don't think they are better or smarter, or even "better rested". The evolving "shift mentality" scares me. There is a difference between taking care of YOUR patient, and writing orders on the patient in room 316. The degree of detachment and the ability to "leave it at the hospital" frightens me. The chasm between doctor and patient is wider than ever before, in my opinion. Not that they don't care--it isn't that exactly--but its just a job to many of them. A well-loved, and usually well-done job, but a job nonetheless.

Can I imagine myself doing anything else? Although I very much want to get out of medicine, I do have to admit that it has shaped my life and who I am perhaps more powerfully than any other force. Hell, it has been my life for the past 20+ years. And I am proud of who I am, what I am capable of, what I have done....Am I like the TV docs? I don't know; do they have any middle aged divorced women doctor yoga teachers with three kids, 3 dogs, 2 cats, and a trashed house to sell on TV?