Exercising the Demons

 

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Scott and I walked into his apartment a bit lighter in the pockets and mildly sleep-deprived. The drive back to Los Angeles hadn’t been more than 4 hours, mostly through the barren desert highway, but it had given us plenty of time to reminisce on the previous 24 hours.

His roommate greeted our return with, “Hey, where did you guys stay in Las Vegas?”

Scott replied, “Oh, just some low-class Motel 6 off the strip.”

She pointed quizzically at the newscast on the TV screen. “You mean that Motel 6?”

We replied simultaneously, “Yeah, why? What’s going on?”

“A few hours ago they caught the sniper there who had been killing people in Ohio.”

I looked at Scott. He looked at me with the same look of disbelief.

We had unknowingly had an uncomfortably close brush with infamy.

The “270 Sniper” had been caught at our hotel in Las Vegas a mere 60 minutes after we departed.

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We had spent the previous 24 hours gambling, drinking, and wandering the streets of Sin City. He had been hiding in our Motel 6, law enforcement hot on his trail.

So when Scott and I recently planned a return trip to Las Vegas twelve years later, we decided to class it up a bit, avoid the Riff Raff, and stay on the strip.

There was no telling whom we would encounter this time around, but we actively sought to avoid any serial killers at The Motel 6.


Scott and I have known each other since 8th grade. His and my parents shared the odd predilection for sending their children to a brand new school housed in a warehouse in the industrial sector of Wichita, KS.

Yes, we went to school in a warehouse. Not like something out of a Philip K. Dick novel, where we would by psychologically programmed to become superhuman automatons.

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But more like a once-vibrant warehouse in the process of being transformed into a new age educational experience where grades were in flux and Love was bountiful.

Actually, Love was very bountiful there, as the up-start school was housed in a Love Box Company warehouse, likely something Walter Love, the company’s founder, would have beamed with pride about.

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While there, Scott and I both were indoctrinated in Logic, Composition, Biology, and Roller Hockey {in reverse order of importance}.

Despite the humble beginnings of our friendship, in a warehouse school in a dusty midwest metropolis, the lessons we learned were paramount to our unlikely professional ascensions. [Except for the Roller Hockey. I don’t really use that for anything.]

Our friendship started over twenty years ago in a warehouse.

Then we managed to avoid a psychopathic serial killer 10 years later.

Now, only a few weeks ago, we found ourselves re-united in Sin City again.


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In the midst of Residency, it has been hard for me to “catch my breath” at times. The completion of every shift, every day in the office, and every licensure task, brings on more things to do, more days in the office, more shifts to be worked.

It seems inescapable.

But that’s why it’s called Residency. In order to be trained properly and efficiently, you are seemingly living at the Hospital, in the office, or a desk trying to complete a seemingly endless list of tasks.

 

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Which is why Scott’s suggestion of a reunion in Las Vegas was utterly brilliant. We both needed a breather from our action packed lives.

Over ten years after our brush with infamy, Scott and I are living lives we simply couldn’t have imagined back then. Scott is a successful Healthcare Systems analyst, having completed his PhD at Florida State after marrying a hometown girl, and now resides in our nation’s capitol with a daughter and another one on the way.

I’m me.

We have kept in close touch since our last destination vacation to Sin City, but if the last 10 years taught us anything, it was to upgrade from The Motel 6.


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When I made my egress from the plane in Las Vegas on Sunday morning, Scott was there waiting; the mastermind to our 48 hour get-away already had the wheels in motion.

We made our way to the Uber pick-up and our driver quickly made a quick connection, identifying that his grown children live in the same city as me. The small talk was brief, as it only took 5 minutes to reach our destination.

Our destination, the MGM Grand, was a familiar location to Scott, as he had visited Sin City numerous times in the years since our last sojourn together; most typically he arrived with his wife, who would be the Chris Moneymaker to his Phil Hellmuth in a pairing of Poker legends.

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But this time, he managed to wrangle a male side-kick, in a Zach Galifianakis in “The Hangover” mold, rather than a Johnny Chan.

At the MGM, Scott managed to finagle an earlier-than-typically-allowed check-in time by not-so-secretively leaving a $50 tip for the concierge. As we calmly and cooly proceeded towards our rooms, I had the feeling our 48 hours of escape in Las Vegas would easily eclipse the 24 hours of chaos we spent there over a decade earlier.


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When I landed back in Columbus on Tuesday evening it was nearly midnight. I was exhausted; and sun-burned. And slightly enamored with a woman I met on a plane.

In addition, I was neither psychologically or physiologically prepared to be a physician again in less than 8 hours.

But in Vegas, when the stakes are high, you can either fold or go all-in. I decided to go all-in this time.

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We may not have had an indirect brush with infamy like back in 2004, but our 48 hours in Sin City made us hungry for more; just as with the genesis of our friendship, there would likely be more tales to tell.

Black Betty

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At 2:17AM on a recent Friday morning I couldn’t sleep.

Not in the sense that I was laying awake in bed, thinking about the cosmos, or wondering how “The Walking Dead” Season Finale would play into any future cross-over series that might be developed, or anxiously awaiting the sun to rise again.

I was actually physically not able to sleep.

As my body was beginning to shut down at the cellular level, the efflux of potassium and phosphorus from every cell beginning to overwhelm my blood stream, the pager holstered upon my left hip started chiming again.

The pager transmitted electrical energy, similar to that of a defibrillator, into my body; the potassium and phosphorus blasted back into the cells, preventing a super-saturated metabolic derangement which would have caused my cardiac activity to cease.

Simultaneously, the loudspeaker in the Emergency Department blared, “Septic Shock Alert, ED 47.”

“Septic Shock Alert, ED 47.”

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I unholstered the pager from my hip, quicker than Doc Holliday when he penetrated Ringo’s brain with a lead slug, and glanced down at the message awaiting me.

As I swiveled and rose from the stool I had been atop for only a matter of moments, I read the message. Thankfully, it only read “Septic Shock Alert, ED 47”, the electrical companion to the overheard communication, instead of 555-9095.

Or 555-9030.

Or 555-9494.

Those numbers belonged to the Hospitalist medicine service, the Intensive Care Unit, and the ED Nursing desk, respectively.

 

Responding to any of those calls would have meant either another patient was waiting for me to admit them to the hospital or an already admitted patient was trying to die in the ICU.

If any of those three numbers had been present, I would have needed to take over the care of the actively dying patient in the Septic Shock Alert, while simultaneously trying to:

1) figure out how in god’s name I would possibly get all of the work done I still had to do

2) supervise my junior resident

3) not lose my mind.

I also probably would have taken the pager and rifled it into the closest wall, hoping to have it explode in a wave of energy like the Death Star in Episode IV.

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My Junior Resident sat beside me, near catatonic from Night Call’s siren song; I tugged at his scrub top, motioned for him to follow along, and let out a long sigh.

I could not sleep.

I was the Senior Resident on Night Call.

Or as I prefer to call her, Black Betty.


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Black Betty is the anthropomorphic representation of Night Call, the overnight shift when physician staffing drops to a skeleton crew and the statistical probability of all hell breaking loose starts creeping up on 100%.

As the sun begins setting on a hard day’s work for most of the physicians, nurses, and ancillary staff in the hospital, Betty begins to rear her ugly head.

Her darkness requires the fortitude of a special type of physician.

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Unless you are a Resident like me. Then you are required to show up to spend some time with Black Betty as a part of your training.

You are not a special physician. You are a Resident. And the only thing special about you is your ability to not spontaneously combust from the lack of sleep you have sustained.

Every Resident dates Black Betty. Some for a night here and there, with no specific frequency or expectation. She does not discriminate.

Others join her for a two week stretch; where her smooth skin becomes chapped and dry by the third night, her velvety caressing hands become stiff and arthritic by the seventh, and her formerly gentle kisses become vicious flesh-tearing wounds as the sun rises on the tenth.

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Black Betty invites the denizens of the night to start shuffling into the Emergency Department.

And the critically ill whose lives are sustained by technological marvels in the ICU to begin their physiologic derangements.

They are joined by the sickly and elderly who become unpleasantly delirious as a result of her rancor.

—–

To this point in my Residency, I have spent over 20 weeks with Black Betty. A majority of those weeks have come in two week chunks, spread over In-patient Medicine, Surgery, and Obstetrics.

But as a now as a PGY-2, the Senior Resident, I have also had more than my fair share of random Saturday date nights with ‘ol Betty.

She and I have been intimate more times than I would care to admit.


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Each date brings about something unique, whether it’s a patient hurtling a chair through a 7th-story window, a near-dead woman’s heart beating in full view of the audience in the trauma bay, or stabbing a needle into a man’s chest to hear the whoosh of air escape and provide his lung the opportunity to re-inflate.

She is fertile with opportunities for us to perform our duties as physicians.

Black Betty had a child, the damn thing gone wild.

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At 2:43AM on a recent Friday morning I exited ED 47 with my Junior Resident in tow.

Black Betty had provided us an opportunity to exercise our clinical judgement, initiate resuscitative measures, and stabilize an elderly gentleman who had tangoed with the Grim Reaper several times in the past two months.

The Reaper’s grasp had tried to choke off the man’s air supply. But we would have none of that.

Black Betty didn’t care. She shrugged it off.

She knew other opportunities awaited.

And my Junior Resident and I would be there. Waiting.

I would not sleep.


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Not when Black Betty has anything to say about it.