There was a dream of being a clinical doctor, handing out antibiotics, and reviewing chemistry panels with patients but it never happened. In surgery, call is every three days. All the residents get call. On the third floor in surgery, the call room is a six by six-foot cell, with a small bed, a table, and a reading lamp. Of course, a phone is also on the table next to the lamp. Tonight Dr. Wracks is on call. After dinner at 6 pm, he will try to get some sleep because reality will keep him up all night. At 10 PM, he makes his first rounds on the surgical floor. The ward is full of patients preparing for surgery or recently out of surgery before being transferred to a medical floor. Surgery is in vogue, and all the people with medical insurance ask for surgery because this is what the affluent do, and they want it too.
Entering every room and speaking his name and position, Dr., Wracks checks the surgical wounds and the heart monitor near the head of the patient. The wound must be dry, if it is wet or red, there exists infection, and if not treated, dehiscence and sepsis will ensue. He checks every patient twice a night because bacteria, especially strep and coliforms have a duplication time of 4 hours and then enter an exponential e to the n logarithmic curve. Looking at the heart monitor reveals arrhythmia. Bacteria produce acid mainly as a byproduct, and acidosis causes arrhythmia and any change in heart rate or rhythm might suggest an occult infection. Auscultation with a stethoscope only shows pneumonia or heart valve defects and is useless, but Dr. Wracks carries one anyway for the effect. After rounds, Dr. Wracks retreats to his cell and tries to get some sleep before the onslaught. He moves the desk, upside down to block the door entrance, and goes to sleep. He awakens as someone slips a credit card into the movable tongue of the lock and tries to gain entrance. The desk moves and creaks and the perpetrator gives up and goes away. They never need to sleep. Dr. Wracks sleeps until 2 AM, it seems after 2 AM everything starts to happen. This is Dr. Ix’s patient and he is the chief of surgery at the hospital. Dr. Wracks grows tired of Anesthesiologists demanding that the residents do not over-sedate their patients because over-sedated patients stop breathing during surgery and die. He has
The phone rings. Dr. Wracks we have a delirious patient in room 355. We want you to take a look at him. Dr. Wracks moves the desk back, puts on his smock, and ventures forth. The nurse beckons him into the room. This is a recent surgical patient with an abdominal procedure.
He says, Dr. I am seeing angels, please help me.
Dr. Wracks listens to his chest, it is clear. The wound is dry. He tells the nurse to contact the primary Dr. Ix because his patient is regressing. All surgeons are on call always and they live near the hospitals where they work. Dr. Ix arrives in Jeans, orders statutory blood work on the patient, and gives the patient 10mg of morphine subcutaneously to calm him down. Morphine works quickly, and the patient sleeps and Dr. Wracks says goodbye to surgeon Ix. He returns to his call room. From Psychiatry at the Veterans Dr. Wracks remembers what Dr. Lecture told him. When a patient says they are seeing angels, death is imminent. Korsakov’s psychosis due to alcoholism produces hallucinations but the hallucinations do not have religious context. Atropism can cause hallucinations but this condition is acute and usually follows an overdose of atropine. He has tried oxazepam, the benzodiazepine with the shortest half-life but it doesn’t work. A thirty-milligram dose of Dalmane puts all the patients at rest while they scream for deliverance before a surgery that might result in their demise, but the anesthesiologists threaten the residents with termination if their patients stop breathing during surgery. Like anything in life, an intrepid soul is damned if they do and damned if they don’t. It seems all the patients get Dalmane before surgery anyway. At two o’clock, Dr. Wracks makes rounds again, introduces himself to patients barely sleeping, and checks their wounds. He sits in the nurse’s station waiting for any immediate entrance from the emergency room. Trauma occurs mainly at night. At four o’clock AM, he will go back to his cell and try to pick up two hours of sleep before showering and going to morning rounds.
He moves the desk upside down in front of the door and wedges it in. Now I lay me down to sleep, I pray my lord my soul to keep, if I die before I wake, I pray my lord, my soul to take.
It is 6 thirty AM and Dr. Wracks is in the cafeteria, alone, drinking coffee with plenty of creamers. The night emergency room crew arrive and wave to Dr. Wracks. He waves back. Dr. Wracks says to himself, I think I am smart enough, four months to go, and it happens again and again, every day without fail.