In case you thought all MDs were nice people....

Today was a rough day. Partly because it started last night at 5:30. I'm the "Night Float" for my team this week, which means that I am responsible for covering the service and all new admissions between 5:30 pm and Morning Report, which is at 7:30 am. Sounds great--just like shift work. Only they don't want you to get adjusted to being up at night and sleeping during the day--that would make you just too alert at 3am. So what do they do? Make you have clinic from 8:30 am to 5:30 pm on Monday. Just to make sure you start out the week already behind on sleep. Then, to complete the picture, you have clinic again on Friday from 8:30 am to whenever you get done (roughly 1pm) after having been up all night Thursday night. So that's where we are: I've been up all night Thursday night, and I've FINALLY finished my Friday morning post-call clinic. Thought I was never going to get done. Ah, well. It's done now.
I'm still trying to process my Thursday night. Our service is pretty busy (we have roughly a third of the inhabitants of this county are patients of our clinic, so when any of those people need to be hospitalized, we take care of them), but we also (like every other doc with hospital priveledges) have County Call. This is where you are the person assigned for the day to take care of anybody who shows up to the hospital without a doctor. So Thursday night was our turn to be on County Call. Not that it makes a whole lot of difference to my service--our patients are the ones who can't pay for anything anyway--except that there tends to be more admissions than usual when you're on county call, and they tend to be sicker than usual.
So about my Thursday night: about 10:30 pm I was in the ER trying to admit my second patient of the night. The third, fourth, and fifth were all also in the ER just waiting on me to get around to them. Well, actually, Admit Number Two wasn't so bad, just a guy with an infection in the skin of his back that needed to come in for strong antibiotics. It was Admit Number Three that gave me the real problems. She was a lady who also had a bad infection. But based on her labs and Xrays, she looked like she had a REAL BAD infection. Like needs to go to surgery to have the infection cut out or she's not going to make it until morning. So...just like there is a County Call service for general admissions, there is also a County Call for consultants: surgery, cardiology, etc, etc. So I have to call the County Call Surgeon. The ER secretary tells me which local Surgeon it is (one that is known for being mean to residents), and pages him for me. By this time it is close to 11pm if not a little after. And sure enough, when he calls back and I present the case to him, the first words out of his mouth are "Why are you calling me?" So I proceeded to present the case again, leaving out everything but the scary stuff that in doctorese is supposed to mean "she needs surgery tonight; get up here and do it." Unfortunately, the infection in question was on a part of her body other than her belly. So Mean Surgeon says, "Call the orthopedist; I don't want to do it."
So what can I do? I call Orthopod. Who asks "Are her bones involved in the infection?" "No sir, from what we can see on the Xrays, her bones are not involved." "Then I don't know what I'm going to be able to add. This seems to be a General Surgery case." (Yes, sir, I thought so too. That's why I called County Call General Surgeon to start with. He made me call you)
So now what do I do? Well, I am a Resident. Which means I am not lisenced to practice on my own. Which means I have an Attending--a teaching faculty who oversees my practice and is there if I get in a jam and need help. This sure feels like a jam, and I need help. So I call the attending. He's supposed to step in and call Surgeon and talk to him. Instead, I tell Attending what's going on, and he says "Well, I guess you're just going to have to call Surgeon back and tell him Orthopod wouldn't take the case." (Wrong answer, Attending!!!!!)
Well, now I'm upset. It's 11:30 at night, I'm tired, I've got three other patients waiting on me to admit them to the hospital, and nobody will take my sick lady to the OR 'cause she can't pay them!!!!!!!!!!!
OK, calm down. Secretary, can you please page Surgeon for me again? After I get him back on the line and tell him that Orthopod won't take the case, Surgeon proceeds to "bless" me with a 10-minute diatribe on how he doesn't like taking care of "your patients" (because in his mind all of my patients don't have insurance and won't pay him--despite the fact that ~75% of my patients have medicare or medicaid or something to help them pay their medical bills). Anyway, when it comes right down to it, he'll come see the patient in the ER, but only if I also get Infectious Disease up out of bed to come see the patient with him so that ID can tell him whether or not the body part in question needs to come off tonight, or if it can just be opened up and washed out. At this point, I'm very upset, but I don't see that I have a choice. Secretary, can you please page County Call ID for me?
Fortunately for me, not all consultants have Surgeon's attitude. ID calls back; I explain the case and the predicament I'm now in because of Surgeon; I tell him that Surgeon will come look at the patient, but only under the condition that he, ID, also come look at her. His response? "So I'm at Surgeon's beck and call?" "I'm so sorry, sir." "I'll be there in about 30 seconds." "Thank you, sir."
Well, they all finally came traipsing into the ER. And my patient did go to the OR. And she did not lose any body parts. And God bless his soul, ID stood there teaching me for 1/2 hour after he had seen the patient and while he was writing his Consult Note. He helped me pick the right antibiotics, he taught me about the infection that she had, and the one she didn't have but I was afraid she did. His parting words to me showed he understood my plight: "The take-home point of this case is this: When you get out in the real world and have your own practice, you will be able to choose which surgeons you call."
God bless that man.