Friday, December 14, 2007


It must be the sunspots. There is no other explanation. I've had so many arguments with co-workers this past week that it must be the sunspot activity affecting everybody. Everyone, that is, except me. It couldn't possibly be because I was on call three days out of the last five. It couldn't be because I was tired and cranky. When I analyzed the situations while soaking in the hot tub after the last on call, I saw that I was absolutely right in all of the situations.

It started when I was on call in the OR. Close to midnight, we were alerted that a helicopter was evacuating a seriously injured soldier who was unconscious and mechanically ventilated. It was a tragic accident. The soldier serving in the armored corps had his head crushed between the breech of the cannon and the roof of the turret. Having served as a tank commander during my compulsory service I knew that this was a rare but terrible consequence of mechanical malfunction, human error, or both. Getting a limb caught in the cannon mechanism was not a rare accident in older tanks. The newer tanks have a failsafe system to prevent this from happening. Something must have gone terribly wrong.

When the helicopter landed I asked my colleagues in the ICU to send someone down to the trauma room because I couldn't leave the OR. I was supervising an inexperienced junior resident who couldn't be left alone. The doctor sent down is a woman we call "the chicken" because she's afraid of her own shadow. It never ceases to amaze me that some doctors don't know their own limitations. She should never have been an anesthesiologist. Sure, she can anesthetize any routine case, but when things get complicated or the patient's condition deteriorates she loses her head. As soon as she got to the trauma room she called me to help intubate. I asked her why intubation was necessary since the patient received an emergency tracheotomy in the field. I asked her what the soldier's condition was, she couldn't tell me. She hadn't even examined the patient herself! I told her that I couldn't come down there myself but I would send her another anesthesiologist from the delivery room to help her. She apparently was not satisfied with this solution and complained to the senior on call in the ICU. The senior was dragged into the general hysteria and she immediately began to shout at me and insult me that I was irresponsible. She also threatened to file a complaint with the chief of the department. I told her she could go right ahead, I was standing by my decision. The doctor I was sending to help is very competent and has even more experience than me in airway management. Besides, if anything adverse happens to the patient currently in the OR, the question will not be IF they fry my testicles, but whether they will be fried in olive oil or butter. Anyway, after lots of frantic telephone conversations and shouting and histrionics and soap opera antics, the doctor in the trauma room finally checked the patient herself and found that he was adequately ventilated and stable. In other words false alarm! A few moments later the senior in the ICU called to tell me that the patient was stable and that there was no need to send another doctor to help out. God forbid she should apologize.

The arguments, mostly stupid, and I remind you that I was justified in all of them, despite being very tired and cranky, just kept happening.

The best and final argument occurred when I was on call in the ICU. I managed to insult a professor of pediatric infectious diseases who is also the director of the bacteriology lab. For some silly reason, any time we need the lab services while on call we need his permission to call the lab tech in. The lab tech, incidentally, is paid to come in when necessary during on calls. So his esteemed highness needed to know all the details of the sample that was sent to the lab. The sample was taken a day before in the OR so I hadn't actually seen it. He insisted on knowing if the sample was obtained on a swab or stored in a sterile cup. I just couldn't figure out why this was so important to him. He chewed me out for not having that critical information. (Later I realized that he just HAD to know because: if the sample is on a swab, then it must first be cultured and then gram stained the next day and viewed in a microscope. If the sample is in a cup then it can be stained and viewed the same day. In other words he wanted to determine if he had to come in the same day or the next day to look into the microscope.) I was getting flustered with his incessant interrogation and I was needed on the ward. I finally told him that I didn't need any favors and hung up.

Well, his royal highness, the Grand Poopah of all Professordom was mortally insulted. He called back VERY angry. I would like to mention that I have a history of insulting higher ups. Even during my compulsory service in the army I somehow had a knack of insulting full colonels and brigadier generals. That I was never punished shows that I have more luck than brains. I tried to apologize, but his holiness wouldn't let me get a word in edgewise. He was adamant that he should educate me in how to be polite to jerks with over inflated egos. He kept telling me not to hang up, that he had just a little more to tell me. Finally, his tirade ended and I could get back to treating the patients in the ICU. For about one millionth of a nanosecond, I entertained the odd idea of actually apologizing face to face. But in a calmer moment, I realized that the one who behaved badly was the esteemed professor of poor etiquette. He's not the first professor I've encountered who causes Emily Post to rotate in her grave. I guess the title inflates the ego and ablates the etiquette gland.

It'll be a cold day in hell before I give that jack-of-all-asses the satisfaction.

It's the sunspot activity I tell ya, it just has to be.

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