Blogosphere Medicine Nonfiction

The Sandwich Incident.

Originally written in 2004, back before electronic medical records were a thing, back before duty hour restrictions, back before “social media” was a catch phrase, back before KevinMD was “social media’s leading physician voice” (and how cheeky I was!).

I knew it was going to be long night when the sandwich fell.

It was an omen.

My medical student had kindly bought dinner for me, as I was unable to dash down to the cafeteria in time before its closure. She smiled and handed me the two plastic boxes: one held a pile of fries, the other, a grilled cheese sandwich.

This sandwich is glazed in rich butter and oozes warm, gooey cheese. The bread is just crisp on the outside but wonderfully doughy on the inside. It is the fatty food that allows the intern to run around the hospital all night.

All you need is lard.

While rushing upstairs to see a patient complaining of “ten out of ten” pain (who was falling asleep on me when I finally did see her), the plastic box holding the heavenly grilled cheese sandwich shifted ever so slightly on the box of fries. I watched the box lazily tumble to the ground and crack open, like a pristine egg releasing its golden yolk.

“Nooooooooo!” I mourned loudly. The box clattered to the ground and the sandwich – oh, that wonderful sandwich – flopped forward and landed on the hospital floor. That hospital floor teeming with VRE and MRSA and MDR Pseudomonas and other letter combinations that only hint at how filthy the floor really is.

The nursing staff and hospital visitors laughed at me as I bent over to pick up the lifeless sandwich. How I wanted to apply the five-second rule. How I wanted to sink my teeth into that joyously fatty sandwich. I had been daydreaming about this sandwich all day. I was salivating as I carried the box around for the past half hour, imagining how delicious and perfect that grilled cheese sandwich would be.

“I love you,” I lamented as I reluctantly dropped the sandwich into the trash can. The visitors looked on, wondering if I was just engaging in theatrics.

If they only knew.

And then the patients stumbled in one after another, three heading into the intensive care unit, their hearts beating very fast, their blood pressures either plummeting to the depths of lifelessness or rocketing towards explosive strokes. There was a lot of running around to collect supplies for lines, a lot of orders being written for things like vancomycin and imipenem and levofloxacin and vasopression and dopamine and packed red blood cells and normal saline bolus wide open and octreotide.

And the pages. “This patient just took off.” “Can you order the bronchoscopy for tomorrow?” “I felt a ball of tissue when I did that rectal exam.”

2:00am finally rolled around and I realized that I hadn’t written any of the admission notes of all of the patients I had admitted. And I still hadn’t eaten dinner. Since that glorious sandwich was now resting in peace in a trashcan.

And the things that ebbed from the pen early this morning! The realms of my dreamworld crossed over too easily to my waking state. My notes included fragments like

and the hypocall team

was awake to go home

which made complete sense when I wrote them, but lacked any continuity or relation to my patients when I finally jerked myself awake. In my sleepiness, I wrote about one patient’s swollen foot in reference to another patient’s swollen leg. Same side, at least. And I didn’t recognize this error until later on this morning.

And the things people said to me today:

“Rough night, huh?”

“You look like death warmed over.”

“You look terrible. I mean, really, you look like s#*%!”

Okay, admittedly, I did look pretty socked out today. The intensive care unit patients kept me hopping all morning long.

And so I’ve been awake for 35 consecutive hours now. I don’t know if last night was just a particularly challenging night – I mean, it was… for me, anyway – or if it’s just that time of year when all of the interns are starting to burn out. I was loudly cursing medicine sometime around 3:00am when I went up to the orthopedic surgery floor to steal food.

Because, again, of the incident with the sandwich.

I don’t think I’ve ever gone to bed this early before. But there’s a first time for everything.

Addendum: Perfect timing—”Sleepy Interns Committing Key Errors, Study Shows“, via Kevin, MD, who probably never made any errors as an intern.