The Things They Carried

Anesthesia Weekend Call Team Edition

Joseph carried the pain pager and a bottle of ibuprofen. The pager had gone off six times since he took over at 7am, which he felt was directly correlating to the severity of his headache. One consult was an elderly woman who fell at a bodega and broke her hip. “Don’t tell my son,” she whispered to him as he evaluated her, and the strong smell of booze wafting from her breath reminded him of the night before, which he spent celebrating a friend’s birthday. His mother would have hated to know how hungover he was, especially since he woke up at 5:30am with a wicked headache, fighting nausea to make it to work on time. She would have lectured him, asking why he couldn’t stay in the previous night, eat a good home-cooked meal and catch up on sleep. What she didn’t understand was that in residency, there was always an excuse not to go out. He found that when he stayed in and prioritized sleep, he woke up isolated, depressed, and somehow still tired. Plus, she knew he wasn’t, and would never be, a good cook. His style of “work-life balance” meant that some days, he was thankful for the nights out, and other days, he was thankful for a job that validated what he’d always figured was true. Everyone’s hips and complex mother-son relationships are pretty much the same: harder to navigate as people get older. “I won’t,” he reassured his elderly patient, winking and squeezing her hand as he set up the ultrasound to block her.

Lynn carried the airway bag. She had been carrying it the whole week, with its tattered, poorly cushioned straps and overstuffed pockets that had broken the zippers on the main compartment. The department was still trying to mobilize funds for a new bag, so Lynn and her coresidents used surgical Kelly clamps to keep the pockets from spilling out. Any time an emergency airway was called overhead, the person in charge of the bag was to run there, navigate to the head of the bed, learn about the patient, draw appropriate medications, set up a blade and endotracheal tube, and safely intubate the patient without causing significant hemodynamic instability. Often, despite the sea of providers in the patient’s room, Lynn had to ask multiple times to learn anything about the patient, to get suction tubing set up in case of an aspiration, or even to have the bed adjusted to her height. When she was done, no one thanked her, which she didn’t need, but sometimes she felt it wouldn’t hurt. What she hated the most actually was when she tried to assert herself in an emergency, ask questions or direct others to help her, and people would respond flippantly, ending the statement with “honey,” or “sweetie.” She was thirty-two years old and had an MD PhD with a specialty in genetic variations that might make someone more susceptible to post-anesthetic delirium. While she understood and accepted the hierachical nature of medicine, Lynn now wondered if pursuing medicine so many years ago had put her on a track that she was no longer willing to accept the consequences of. While she was in the thick of her schooling and dissertation, she had watched friends’ lives progress, celebrating with them as they told her of new relationships, hobbies, and achievements. In contrast, Lynn had hobbies, like Muay Thai, that she had never found the opportunity to truly master and a cat, Felix, she absolutely adored, but never got to see. At this point, if another person called her “honey” this week, she had decided to leave this career entirely and starting a new life selling feet pics on OnlyFans, where the hours were flexible and she would get paid to be referred to derogatorily. Lynn initially carried the bag with pride, but today, her seventh consecutive day as the airway resident, she carried it with exhaustion, irritation, and the incessant thought of quitting medicine for something that offered more peace and satisfaction.

Mariah carried her engagement ring, a modest solitary round in a white gold four-pronged setting. Her fiancé, a surgical resident, had proposed to her in December. It was now May, and they had made minimal headway on planning any of the details of their wedding. How could they, when they were on opposite call schedules? When they first got engaged, after much coordination with program directors from both programs, they were able to schedule a day sixteen months in the future where neither of them would have to be on call. The rest of the details would have to wait until their schedules “lightened up,” which Mariah recognized, spinning the ring absentmindedly around her finger, was a delusional notion, considering she had two years left of residency. The pulse oximeter ticked unnervingly in the background of her cholecystectomy case while she emailed wedding DJs on her phone and coordinated a time to try on dresses while her sister was in town. She was confident her actual wedding day would be beautiful, but knew getting there would be like running a marathon while pushing a hospital bed. 

Dr. Andrews carried the attending phone. Over the last six months, he carried the attending phone for in-house weekend calls once a month. His wife hated these weekends, especially since she was alone with the baby, but he kept reminding her, even if he missed his son’s first steps or first words, it was a necessary investment. His first week in the operating room as an attending, he had unexpected difficulty securing the airway for a patient. The room was tense, and his panic was visible as multiple anesthesia attendings worked together to safely guide the endotracheal tube past the vocal cords. While many people advised him after the fact that he had taken the right course of action, the experience left his nervous system fried and rattled. When Dr. Andrews graduated residency and fellowship, he thought the game was finally over. He had won by doing the work, earning the respect in the old-fashioned, calloused, red-eyed, teeth-gritting way that all who came before him had done. Now he realized, he had just leveled up and the game just continued, with his name now at the top of the chart. Every extra call and extra case he did was a way to prove to everyone, including himself, that he was capable of this job.

Around 2pm, the call team carried their lunches to the lounge. The last emergency case had just ended, and all the consults so far had been seen. They ate together, family-style, a meal of fast food burgers and fries, Dr. Andrews’s treat. Mariah was the only exception, quietly devouring her meal-prepped lunch that she and her fiancé had made together the night before. They watched the football game in the background as they ate and discussed what she hoped her wedding decor would look like. Dr. Andrews FaceTimed his wife and son, and the whole team joined in to say hello. Joseph treated himself to one of the stale donuts on the windowsill left over from earlier that week, which he claimed still held up, much to Lynn’s visible disgust. Dr. Andrews helped Lynn mend a hole in the airway bag’s side pocket, which held oral airways of all sizes, in yellow and red and green. They all walked to the window facing the river and watched the sun and the boats and the people walking their dogs along the promenade.

At 2:37pm, three pagers went off at once. There was a new pain consult from SICU, a polytrauma arriving in the ED, and a code occurring on the medical oncology floor upstairs that would need an airway. Fries and half-eaten meals were abandoned with intent to return, although unclear what hour that would be, and the team quickly and dutifully dispersed to attend to their patients.