Tomorrow I go back to being on call every 4 nights in the hospital. I’ll be on call this Friday night. Amy was a bit disappointed when she found out since there’s a big nurses’ party that evening. It costs $18 a person and she already bought me a ticket. She asked me last week what are the chances I’m on call that night. I told her “25%” although I thought “90% knowing my luck.” I was right.

I wasted the entire month of November. Well, I had fun in the beginning but the guilt has caught up to me. No sense in worrying about it now though. Just pick up the pieces and prepare for the shrapnel aftermath.

I’m already missing the days where I could just lie naked with/on/under Amy’s warm softness in bed and then fall asleep dreaming of the same thing.

Now I’ll be dreaming of my beeper going off in the middle of the night for some CPR and then realize I’m not dreaming it.

I’m preparing myself. Went to the gym yesterday and going tonight. “Strong body, strong mind.” That’s what Teddy Roosevelt said, at least that’s what I wrote in my personal statement once. Evidently no one reads personal statements because I got in where I was applying. Maybe it was for this residency even. At least if my muscles are sore I’ll know they’re not atrophying. One less thing to concern myself with.

I’ll balance my checkbook tonight too. It may be another month before I feel like looking at it again or paying my bills.

My whitecoat carries the things I need while mobile. A drug book. Prescription pads. Stethoscope. Reflex hammer. Flashlight. Vending machine change. Two pens because you always lose at least one. Toothbrush and a mini tube of toothpaste.

MEDICAL SURVIVAL TIP # 12: When on call, brush your teeth. You’ll feel better and your patients (or your colleagues for that matter) might not look so sick the next time you talk to them.

I used to carry a review book or two. Interns usually do but you lose the extra gear the higher you go up in command. Some say it’s because your knowledge base goes up. But even a senior resident can’t remember everything in those little books. I think it’s just a confidence thing. Or just the weight in general that you get tired of after your intern year. Some attendings even lose the whitecoat.

I have two beepers now. That’s the sign of seniority. Medical students sometimes have one, and if they’re lucky it was made in the current decade. Interns always get a beeper. Seniors get two. One for incoming patients and one for everything else. That way you get the stereo effect when your new patient in the ER and your floor patient start crashing at the same time.

MEDICAL SURVIVAL TIP # 14: If you’re ever surrounded by a group of hostile doctors with sharp objects, just lob a beeping pager at them and as they all fumble for their own pagers make your get-away.

Probably the best thing is to expect you’ll be there late even on short days. Because something always happens. No expectations, no disappointments.

MEDICAL SURVIVAL TIP # 3: The longer you stay … the longer you stay. (This goes for medical professionals as well as patients.)

So tomorrow morning I go in and have to pretend to be “The Man” again - the senior resident. I’ll have one intern and one sub-intern (4th year medical student) on my team. The senior handles the problems the intern isn’t experienced enough or confident enough to handle, usually those “do something or they’ll die” times. Plus I have to oversee the rest of the patients on the service.

So that’s what I carry in all those pockets. Things I’d like to get rid of that I’ll be carrying with me would include :

Dread. Fear. Uncertainty. Fatigue. But those just go with the job … any job I would imagine. Where’s the excitement? I get to be like those docs on ER and all. I get to make a difference, at least that’s what the brochure said. I get to see things that no one else short of a serial killing cannibal will ever see up close. It WAS exciting for the first month or so as a student. After that, the reality and the responsibility and the uncertainty and the-things-you-missed and the yelling/crying families and the-looks-of-all-knowing-despair kick in. Once in a while though, some patient will say “I like you” or “You’re a good doctor” and then it’s all new again. Nevermind that the patient is demented and thinks that you’re the Easter Bunny and he just met you you 3 seconds ago. I’ll laugh it off and say the patient needs a “Psych consult STAT” but deep down he just became my favorite patient.

There I go again. The wrong attitude. The Reasons get confused sometimes.

Sometimes you forget who the enemy is. Heaven forbid, sometimes you think it’s the patients. Especially the ones who give themselves away and fake illness to get their drugs just to make themselves feel better and you feel worse. Sometimes you think it’s your colleagues when you’re arguing with them about whether this patient should go to their cardiac service or the surgical service or the intensive care unit. Any service but yours. These are the things your doctor won’t tell you. The petty squabbling behind the scenes. Turf battles.

So tonight I have my last worry-free sleep for a month. Tomorrow I’m paratrooping into Ground Zero. A different chapter compared to the past month but similar to the one before. And I guess I would be the hero, or anti-hero, of this story. I’m not quite sure yet. But at least at the end of the story I’ll survive. Most everyone else dies … well, not really, just the ones I’ll remember.

Damn, I just gave away the ending.

MEDICAL SURVIVAL TIP #1 : When on call, call your significant other … that is, if you have one and would like to keep it that way.