Smoking is the devil

"Hoedit, hoedit!" An escalating raspy voice calls down the hall to hold the elevator and his electric wheelchair whizzes into view as the doors close. I lunged for the open door button since my attending, chief resident, and two drunk guys in the elevator with me all seemed blissfully oblivious to what was going on.

I had seen him before in the halls. His long, thin frame propped awkwardly on his wheelchair, his body stiff. Most of both his feet are missing, bandaged and oozing but somehow he manages to hold his IV pole between them, in front of his chair as he motors around. The stubs of his index finger and thumb on his right control the joystick on his chair. I don't think he has any teeth and appears to be hooked up to a milky-yellow IV bag for all his nutrients. His pale face with sunken cheeks and stubble is friendly, the toothless grin never leaving, an unlit cigarette between his lips, he's on his way outside for a smoke. Smoking 'till his last days.

Yesterday was my first day of general surgery, and as Murphy's law goes, I was on call. Unlike obstetrics, there is no senior resident or attending staff 'in house' so you're it overnight unless something big happens...then you're it until help comes. The reason I bring up my friend with missing fingers and feet is that the general surgery resident on call 'cross-covers' for all the vascular surgery patients overnight. The vascular resident gave me a call before she went home (after her 36 hours stint or so) to let me know about some patients I might 'hear about' overnight. Two of them had various levels of legs amputated, both DNR (do not resuscitate). "We really thought they'd die over the weekend, so any day now really, just make sure they're comfortable." Vascular surgery seems terribly depressing. Reconnecting and propping open arteries in an attempt to get perfusion to limbs. Arteries choc-full of nasty fatty plaques from long lives of smoking, high cholesterol, diabetes, and obesity. When people think of why they shouldn't smoke they probably think of lung cancer, but really, the heart attacks and rotting amputated limbs ultimately affect more people and needless to say, the impact on quality of life is fairly monstrous.

So I scrambled to figure out the patients on my own team, before reviewing the other general surgery team's patients AND all these vascular patients who had had surgeries I understood in only a simple textbook manner.

My senior resident left at 8pm after we had swamped our way through about six consults and booked an appendectomy for surgery later that night. I had a clear 'to-do' list in my mind of paperwork, dictations, labs and a CT scan to follow-up on to make sure we couldn't 'turf' one of our patients in the emergency department to GI and avoid admitting her. It was quite clear that I should call him only if I was really really uncomfortable with what was going on, in which case I should definitely call him...a fine balance.

A call from the ward at 2am.
"Are you familiar with Mr. Jones?"
"Nope. But you can tell me about him."
"Well, he doesn't have a pulse (I swear there was a pause here) in his left foot."
"Oh...what surgery did he have? Has he ever had a pulse in that foot?"
"Bilateral fem-pop last week." Pause. I hear the flip, flip, flip through the chart. "Actually, I guess we haven't ever picked up his dorsalis pedis pulse."
"Good...uh...I mean, not good, but no change then. Are his vitals stable otherwise?"
"Yes, sorry to bother you."
"No really, its okay, thanks for letting me know."

I clunk the phone down with relief. After clicking the light off, I lay down again on the ancient, hard, creaky hospital bed with thinly disguised rubber pillow that are standard in the call rooms. I'm exhausted but sleep and adrenaline don't mix well. Constantly dreading a call about my little lady with a bowel obstruction whose pain I just got under control an hour ago. The knowledge that I also hold the trauma pager is like a ball of lead in my stomach. I do get some sleep, but the pages continue, slowly I get comfortable and my heart stops pounding each time I hear the beeping.

Morning does eventually come. No one died, well, on my watch at least. The frenzied surgery rounds begin. Warp speed in and out of patients' rooms so the surgery residents can get to the ORs on time. When we finish the chief turns to me and says in a cheery voice, "I know you're post-call, but there are some great cases in the OR today. They'd be perfect for you to see as an OB/GYN resident. You're free to stay all day if you'd like!" Honestly, I wasn't really sure if he was serious or not... since I had only know him for a day I chose the 'serious' option instead of breaking into uncontrollable laughter like I felt like doing. I ended up staying for two surgeries that admittedly were very relevant and they actually let me do a fair amount which was a good trade-off for bleary-eyedness. Too bad for the ani of those involved of course.