“You got that right,” Mitt said. Andrea was correct that they both had more immediate concerns. “I even had trouble falling asleep last night.”
“What’s your biggest worry, when all is said and done?”
“I suppose my biggest is when I try to imagine what it’s going to be like tonight when I’m alone and on call and possibly facing something major, like a cardiac arrest.”
“How do you know you’ll be on call? Did you volunteer or have you heard something I haven’t?”
“I should have said if I’m on call,” Mitt quickly corrected. He gritted his teeth. There was no way he wanted to get into any kind of discussion about his prognostic abilities.
“If that is your only worry, you are way ahead me,” Andrea said. “I’m even nervous about daytime and dealing with all the experienced nurses who know a ton more than I do about actually taking care of patients. I mean, my knowing the intricacies of the human immune system or the molecular detail of intermediate metabolism isn’t going to carry much weight when it comes to handling a chest tube.”
Mitt had started to agree when the door to the hall burst open and in swept the chief surgical resident, Dr. Vivek Kumar, like a minor whirlwind. Trailing along behind him at a respectful distance was a female resident. With only a brief nod in Mitt and Andrea’s direction, Dr. Kumar stepped behind the podium. The second resident stood off to the side, intently eyeing Dr. Kumar, as if waiting for a cue.
Chapter 4
Monday, July 1, 7:30 a.m.
“Okay, I’m going to make this short and then turn you over to Dr. Van Dyke here, who supervises first- and second-year residents along with our rotating third-year NYU medical students. My name is Dr. Vivek Kumar, and I am the Bellevue Hospital chief surgical resident. I assume you remember meeting me briefly during your orientation over at the medical school last week, but then again you were being introduced to a lot of people. What I want to do this morning is give you two newbies an idea of what specifically you will be facing here at Bellevue over the next two months and what’s going to be required of you.”
Mitt certainly remembered Dr. Kumar and had been impressed from the moment he laid eyes on him. Mitt’s favorable initial assessment was now being confirmed in spades. The man, who had arrived at precisely the time specified, radiated an aura of total confidence along with a vast and almost inconceivable knowledge of medicine, particularly surgery. And now, perhaps because he was on his home turf and feudal domain, he also projected an expectation of excellence and hundred percent commitment along with a low tolerance for suboptimal performance. Mitt briefly glanced over at Andrea, wondering if she felt the same intimidating vibes.
Returning his attention to the chief resident, Mitt saw the man was of average height and inordinately handsome, with a trim silhouette and movie-star good looks. His dark complexion and particularly thick, shiny black hair were highlighted by his outfit. Kumar was dressed as the quintessential surgical resident plucked from central casting with a spotless, highly starched, and wrinkle-free white doctor’s coat over sharply creased white slacks. There were a few colorful pens and a lone penlight in his breast pocket, and a stethoscope was slung casually around his neck.
“You two are about to get your first taste of the power and joys of the practice of general surgery,” Dr. Kumar continued. “And from the word ‘go’ you will be key members of our team. Particularly at night and on weekends, one of you will be the first line of defense for any problems with our in-house surgical patients, both on the surgical wards and in the intensive care units. Of course, you will have the support and backup of on-call second- and third-year residents, who have consultation access to us fourth- and fifth-year residents, along with our talented attending staff, but you will be called first to analyze the situation and decide how to proceed.”
Mitt again looked briefly at Andrea, and this time she returned the glance. The choice of the initial comments by the chief resident served to fan both their anxieties, especially his mention of intensive care units. Everyone, including medical students, knew that the ICU was where the most critical patients, those with sophisticated and potentially life-threatening needs, were located. For Mitt and Andrea to face such situations at this point in their training seemed beyond their capabilities.
“Starting this morning you will be assigned specific patients who are either in surgery or scheduled for today. These patients will officially be yours to follow closely and manage with the support of more senior residents and the attending surgeon. Also, today you will be assigned patients scheduled for admission and surgery tomorrow. These people will also be your patients. What that means is that you will do the admission workup, prepare them for their surgery, assist at their surgery, and then manage their postoperative course. Each day at morning rounds, which start at six thirty sharp in this room, you will have already examined each of your patients and be in a position to present their conditions to the entire team. Are there any questions so far?”
Mitt’s anxieties ratcheted upward, and he glanced yet again at Andrea, who nervously returned the look.
Dr. Kumar paused, staring back at the newbies. When neither gave any indication they wanted to speak, he continued. “This all might sound like a lot of work, and for good reason. It will be. But there’s more. A weekly three-hour protected educational block must be respected, meaning besides your clinical responsibilities, you will be required to attend our SCORE lecture series, which our senior residents present in conjunction with the appropriate attending surgeons. Additionally, you will also be expected to attend Thursday grand rounds, provided your surgery schedule permits, as well as various departmental conferences, including most particularly the Mortality and Morbidity Conference. On top of that, you will be expected to spend time in our simulation center, particularly to gain familiarity with laparoscopic instruments and techniques.
“What you are hopefully gaining from my remarks this morning is the clear understanding that you are here at Bellevue primarily to learn, and we want to make absolutely sure that happens. Any questions at this point?”
Both Mitt and Andrea were too intimidated to ask questions, and both unconsciously settled more deeply into their respective seats to avoid calling attention to themselves. At the same time, Mitt knew that there was a conflict between learning and service, particularly during the first year of residency. First-year residents were, when all was said and done, remarkably cheap labor and had been historically abused as such. The year was, in reality, exactly the same as what used to be called “internship.” When the abuses that interns had suffered became common knowledge, the name changed but the demands didn’t.
“Okay,” Dr. Kumar said. “I’m glad we are on the same page. Still, there’s one more important issue I want to raise. Our program here at Bellevue respects the Accreditation Council for Graduate Medical Education, or ACGME, decision on resident work hours. We are serious about adhering to the limit of ‘eighty hours per week over a four-week stretch.’ You will hear more about this issue from Dr. Van Dyke. That’s it! How about now? Any questions for me?”
Mitt and Andrea didn’t dare to breathe lest any movement might draw unwanted attention.
“Okay,” Dr. Kumar said with a brief hand clap followed by a gesture toward Dr. Gloria Van Dyke. “Now I’ll turn this over to one of our talented third-year residents. She will be filling you in on some of the necessary details and getting you started on your journey.” With a final nod toward the two first-year tyros and then to Dr. Van Dyke, he briskly exited the room.