“Leaving the hospital every night becomes a bit of a mental cage match: Look up, see someone you know, and you may never get home,” writes Christopher Bayne, MD.
|Christopher Bayne, MD||UT|
“Patients don't choose when they get sick,” a senior attending once told me over the phone on a midnight of my second year of residency. A pillow muffled his scratchy voice as it downshifted to a deep drag through the progression of the sentence.
Patients don't choose when they get sick. If you’ve ever taken call, you know this to be true. Patients get sick. They get sick at 2 in the morning, not 2 in the afternoon. Several times, my pager has beeped as soon as I have sat on the toilet. I’ve stopped to help a patient who went into cardiac arrest in front of the hospital cafeteria only to have it close during the minute I intervened before the code team arrived.
After 9 o’clock at night, my hospital funnels exiting traffic through the emergency room waiting room. Leaving the hospital every night becomes a bit of a mental cage match: Look up, see someone you know, and you may never get home.
On this one particular night, I looked up. I spotted a familiar patient sitting in the waiting room with his wife. I had discharged him a few weeks earlier following his recovery from a large cancer surgery. His clothes told me he had spent the day on his couch. His wife had two hands wrapped around one of his.
Our eyes locked. I wasn’t on call. The Accreditation Council for Graduate Medical Education doesn’t have guidelines for situations like these.
I greased the wheels and got my patient and his wife in an exam room. We talked about how he had been at home and what was wrong now. I made a differential diagnosis, ordered some tests, and called my attending. After entering admission orders and writing a note, I left the hospital, this time detouring through the ambulance bay.
Next: ' “Off the clock” and “off call” don’t really exist.'
Patients don’t choose when they get sick, which is to say the profession of doctoring doesn’t have shifts. “Off the clock” and “off call” don’t really exist. I’ve been in the hospital just as late with my pager off as I have been with it on.
As I wind down my chief year of residency, I think about the line between my profession, my patients, and the time I reserve for my family. I don’t know where that line is, who draws it, or whether it’s drawn in sand or cement. I know I will occasionally be late to my son’s baseball games. I expect to have to cancel dates with my wife. Hopefully, I’ll be part of more than I miss.
Three years after that night in the emergency room, my patient was in a neighboring hospital for a routine health-screening exam. My mother was his nurse, though at the time neither knew the other’s connection to me. The patient’s wife recognized the last name on my mother’s nametag and asked if I was her son. Both the patient and his wife vividly recounted that night in the emergency room to my mother.
I was shocked when my mother told me of her chance encounter. I had forgotten about that night in the emergency room. The patient and his wife still remembered.
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