Atul Gawande

       Another night on duty. The day was like usual. My first case was an operation on a woman with escalating attacks of belly pain. Gallstones were causing the pains, so we removed her gallbladder (chock full of stones) using a small camera and long instruments inserted through tiny incisions in her belly. In my first year I’d stare at the TV screen, trying to keep the camera still with one hand while picking at the gallbladder with the other. Move one way with your hand and the instrument moved the other way on the screen. I thought the operation was maddening, and the attending surgeons thought I was. Their patience would soon give out, and they’d take the reins. Like learning a new video game, though, I eventually got the hang of it. Today, I got it done in an hour, and the attending only had to give me a few tips here and there.
       By the end of the day’s surgeries, I am puffed up and gleaming with self-satisfaction. Don’t ‘Mister’ me, buddy. I’m Doctor Gawande. The nurses, sensing my growing smugness, set about bringing me down to size.


7:00–Rounds are over. One team member is still operating. The others fill me in on their patients. Things seem under control and they head home.
7:01–Page. “Your new patient’s here.” What new patient? I meet him, and he’s yellow as a banana. Turns out to be pancreatic cancer. Inoperable. I figure it’ll take an hour working up his problems. But I’m hungry.
7:25–I rush downstairs before the cafeteria closes. Dinner is fried chicken and mashed potatoes. (The hospital cafeteria manager must get kickbacks from cardiology.)
7:27–Page. A nurse says there’s a man on the phone who’s furious that we’re sending his wife home tomorrow. I say to make him wait, but she puts him on anyway. “This is crazy,” he says. “In Russia, she would get one month in the hospital.” I note that she’s eating, walking around, and taking only pain pills. He vows not to pick her up until he feels she’s ready. Whatever. My chicken’s waiting.
7:29–Overhead speaker blares, “Code Green on the seventh floor.” This means someone’s stopped breathing. I abandon dinner and join a platoon of residents descending on a man who had a lung removed because of cancer. One resident inserts a breathing tube through his vocal cords. Another puts him on a respirator.
7:45–I’m back to my chicken. Another page. “Mrs. Z is itchy all over.” I ask if she has a rash. Put on hold.
7:48–Still on hold. I hang up and call back. They forgot me. Yes, the patient does have a rash. I figure she has an allergy and change her antibiotics.
7:50–Page. “Mrs. B isn’t making enough urine.” I head for her floor. This time I bring the chicken. She’s pale, dizzy, and dehydrated. Her blood count’s low. I give her some blood.
8:10–Page. My young splenectomy patient has a fever running to 102 and is throwing up. Damn it. I thought he was on the mend. I go see him. The pneumonia is still festering. I give him Tylenol and anti-nausea medicine to make him feel better.

       With my ego back to shrunken, resident size, I sneak off to my “call room”–a closet with a bed and a desk. I finish off the chicken and call home to see how Kathleen and the kids are doing. Another page. I gird myself for the long night ahead.