Sorry I'm Too Drunk to Come In

I have never actually been too drunk to come in, but I did have to say this once.

When I interned I had a surgery elective. There are a lot of interesting things I could have done but for some reason I decided to orthopedics in the Big Teaching Hospital (BTH). I was going in general practice, I really felt I should do some ortho. I didn't do an elective as a student intern because I figured I would get to do more and learn more as a fully fledged MD. How could I be so stupid.

Now maybe I had had a sheltered life or maybe my expectations were too high but up until that point in my life, I had never been treated like a piece of shit, that way I was treated during the four week rotation. Unfortunately that was to be exceeded later in my internship.

During our rotation we did call 1 in 3. This was not unusual in the early 1980s. In fact one in three was considered by many to be ideal balance between education or sheer torture. 1 in 2 is too much (plus you miss half the good cases), 1 in 4 means you miss out on on call experience whatever that is. One feature of 1 in 3 call is it makes weekends a theoretical concept. You are either on call Friday night, all day Saturday or all day Sunday.

Sunday is of course the worst day to be on call because that means you are on call the following Saturday, a seven consecutive day stretch. But, you could say, "At least you have Friday night and all day Saturday".

Ortho (and many of the surgical services) had a way of dealing with this. Mandatory Saturday morning educational rounds. Each Saturday from 8-12 we would have to attend the residents' educational rounds, 4 mind numbing hours of internal fixation systems and joint prostheses. OK but you still have Saturday afternoon? Think again, since you well there, you were expected to round on all the patients on your service and do all the scut work that piled up on ortho. If you were lucky, you might get out by 2 pm. (They also expected you to come in Sunday for the elective admissions which included drawing all the bloods and doing the ECGs).

So it came on the third weekend of the rotation that I was on call on Sunday. In the scheme of things this meant I was on call Thursday. Normally ortho was moderately quiet, lots of IV restarts on confused LOLs, sorting out medical problems etc but you could usually get a few hours sleep. That Thursday night was an exception with a major trauma followed by one of our patients having a respiratory arrest. Then of course one of the staff on our service wanted to round (ortho staff only rounded once a week!) which took us until 6 pm.

I walked home, ordered pizza opened a beer and I was asleep by 9 pm. Now I still really believe that I honestly forgot to set my alarm for 0700 which would have allowed me to get to the hospital in time for rounds and that I didn't intentionally not set it but it was 10 am when I woke up. I felt a little guilty but since I had probably already missed the best part of internal fixation systems and since I remembered that another intern had not showed up the last week, I got up putzed around, had coffee, read the paper; the things normal people do on Saturday mornings.

I can't remember why I was still home at 3 pm or why I answered my phone. It was the hospital and the student intern on call was on the line. He told me that the intern on call had phoned in sick, that they were really busy and could I come in.

At that time I could have said any of the following:

1. I'm sorry you have the wrong number.
2. I'm on call tomorrow and there is no way I am working two nights in a row.
3. There is nothing in my contract that says I have to cover sick calls.
4. Instead of delegating the call to you, why doesn't one of the residents call me and we can talk about what I get in return.

None of these seemed right at the time, I had to think hard about why I couldn't come in. It came to me in a flash.

"Well", I said, "I'd love to come in but I've been drinking since noon." "Oh," said the student intern, "I'm not sure what the rule is about that". "Well I know what the rule is," I said, " and I am sorry but I can't come in." Opening up my first bottle of beer with my spare hand.

I felt a little guilty about this, but as time goes on I feel less and less guilty.