Where lies the oversized professional and social power of, us, physicians?
Financial recourses? No. Political power? No. Social Influencing? No.
It resides in the fact that we can make split-second Life or Death decisions.
When we were doing our internship in a large New York City hospital, we had to do a 24 hours-On Call stint every three days, which meant that we spent a large amount of time in the facility, working side by side with dozens of residents from across all the specialties and training levels. When our duty was done, we liked to meet in the large On Call room to have a snack and watch TV together. Yes, those were the times when we all participated in the same viewing. No nasty arguments.
One day I showed up with a tuna sandwich and saw a black and white TV program where there was a smiling fat bus driver fighting with his blonde wife in their living room.
-“Mario,” Steve, a fellow intern said to me, “have you ever watched this program?”
-“No, “ I replied. “What is it?”
-“The Honeymooners. Sit down. You’ll love it, buddy.”
From that moment on we got hooked on the funny episodes of a sitcom featuring ralph and his wife Alice, which had made its debut in 1951, before we were born. It was comforting to share a meal and distraction with other Young Turks…Until.
-“CODE BLEU IN THE ICU,” the loudspeakers blared. And all our beepers (small digital devices that we had to carry with us, even to the bathroom) started ringing.
We all dropped whatever we had in our hands and stampeded out to the exit door. There was no time to wait for the elevators , so we ran up the stairs to the third floor where the ICU was located. Usually there were other interns and residents already there, working on the Cardio-Pulmonary Resuscitation of the compromised patient.
However, we all just stood in silence, waiting for any instructions or orders. Just like in the Military. Once the loudspeakers called the Code off (either because the patient had survived or , much more commonly, because he/she had died) we all left.
This drill was repeated once or twice every time we were On Call. Again. And again…Until one day what we , the rookies, secretly dreaded did happen….When we arrived at the ICU or the wardroom where the Code was called for, we were met by the Head Nurse, who summarily told us: “Get ready. The nurse started. Go.”
We were ushered into the room where the nurse was pumping oxygen into the patient’s mouth with an Ambou bag; another one was trying to get an intravenous line. Often the anesthesiologist On Call was there, getting ready to intubate the patient. But on that occasion, he was busy in an emergency surgery in the operating room; we, the interns, or residents, had to intubate the patient. No delay.
Note. This image of a World War II poster for Nurse recruitment in the Navy was taken from
The first time a nurse handed us the intubation kit, we almost fainted to the floor. We managed to grab it and we went behind the patient’s back. We opened his mouth; we slid the apparatus down the left side of his mouth and then pulled our hard upwards. The first orifice that you see belongs to the Digestive tract. You have to pull the handle up to see another orifice, exactly in front of the other one, belonging to the Respiratory tract. We slid the previously lubricated tube in a diagonally upwards direction. We asked the nurse to check the positioning of the tube. “Good. Doctor.”
Before we came to the USA to do our Post Graduate training, we worked for two years at two small countryside hospitals in Buenos Aires province, where we usually covered all the Emergencies for the whole weekend, assisted by the attending physicians. They often responded but sometimes, they were MIA; it usually occurred when the philandering docs put the excuse of “I am On Call” to their wives in order to meet their lovers in a love shack by the Riverside. We kept mum.
One night we had just taken the On Call service in the public hospital in San Miguel del Monte and their top clinician stopped by at dinnertime to duly warn me:
-“Hey, my new sweetheart wants to see a play in La Plata, and we are leaving now.”
-“La Plata?” we shot back. “”That is almost one hour away in the fastest car!”
-“Don’t worry, you are doing fine here with us. When we’re back, I’ll stop by…”
A little anxious, we nonetheless made the final rounds and went to bed at midnight.
At 2 AM, the Chief Nurse barged into our On Call room and turned the lights on.
-“Doctor, Mrs. X came to the ER…She’s due in these days…Hurry up.”
Of course she was referring to a term pregnancy attended by the Lothario.
The nurse escorted us to the Obstetrics section of the ER where a young woman was already in the exam chair with her legs wide open. Next to her stood the anesthesiologist who was slowly dripping some pain medication into her spine and the midwife, ready to take care of the newborn.
AND THEY WERE ALL LOOKING AT ME.
-“Hurry Doctor, the baby wants to come out…Here, give your hand and I’ll show you, ” she said before taking over the motricity of our two Upper Extremities to go through the motions. She handed us the cutting knife and took a big piece of the patient’s vulva. “Cut here, “ she said showing us how to do an Episiotomy.
-“Push, push,” the midwife ordered. Exhausted, the patient made a last muscular effort. And in a few seconds, we could grab the amniotic fluid- covered head of a boy. With her help, we could deliver a healthy boy and we gave him to the mother so she could feel him; the midwife cleared his nostrils and enveloped him with a blanket.
-“What’s his name?” I asked the mother.
-“Federico,” she replied.
Smiling with pride, we went back to our On Call room to write a letter to our dear grandmother Yolanda in Montevideo, to tell her the whole story. She was henceforth very proud.
These clinical events marked by critical split-second decisions can only be handled by highly educated and trained physicians and nurses. It is our earned prerogative. It is the basis of our professional reputation and social standing. It is the largest feather on our cap. WE EARNED IT.
No bean counter that seems to enjoy harassing us with their micromanagement BS, will ever be able to match us. Let us continue to study and train intensively to continue being quasi-indispensable.
We love our Medical Profession and will practice it until the end of our lives.
Stay distant. Stay safe. Stay beautiful.
What do you think? Please tell us.
Don’t leave me alone.