Thursday, April 10, 2008

Call nights and superstition

I'm on night float again, meaning I show up in the evening and man the call pager until the troops arrive again the following morning. A night on night float can range from eerily quiet--prompting such incredulous behavior as paging oneself to ensure that the call pager still works--to frantic, with no end to the work and seemingly every patient trying to die off on your watch. One would think that there would be such a thing as an average night, and that we woudl have roughly a normal distribution of nights ranging from quiet to scarily busy. However, it seems more as though, rather than normal, the true distribution is bimodal. You either get killed or you float by. Of course that's an oversimplification, but the fact of the matter is that you never know what a call night has in store for you, and whether you'll walk out the next morning smiling at the brilliant sunshine or just hoping it will illuminate the path to the nearest trashcan in which you can deposit your pager--and your career--post-haste.

In part, I think this unpredictibility contributes to the learned helplessness that comes to characterize the junior resident in neurosurgery, but that's a topic that I'll address some other time.

For now, I just wanted to mention that superstition has a stronghold among neurosurgery residents. And when I use the term, "neurosurgery residents," I mean me. For instance, my face itches. Badly. Why? Because I haven't shaved since last Saturday night. I haven't shaved because I've had good nights all week long--a rarity, and in fact a statistical singularity--and therefore the reptilian part of my brain concludes that the unifying thread for each of these benign nights, my growing facial hair, must be the reason why. So, of course, I can't shave. Far better to scratch my neck, uncomfortably contort my face every couple of minutes so that other residents diagnose me with Tourette syndrome, draw the ire of my chairman (who thinks that every resident should be clean-cut), and suffer the ignominy of walking around with my sorry translucent excuse of a beard. ("Hey Ian, is that dirt on your face?") I only have one more night this week, and my facial hair can get me through.

Of course, I've now just completely jinxed myself. Tonight I'll probably have about twelve consults and three ventriculostomies.

One of my attendings, though, once posited an interesting hypothesis. He said that perhaps the future--in this case, a call night--is comprised of a finite number of realities (future quanta, if you will), and that each of these possible realities already exists in different dimensions of what might ultimately constitute the future. However, the Heisenberg uncertainty principle, or something akin to it, applies to these future quanta just as it does to the momentum of an electron: that is to say that by observing one of these future quanta--by predicting it or calling it to mind--we alter it, and from the standpoint of its potentiality for a future outcome, render it infinitely less likely to occur. For this reason, then, it behooves the neurosurgery resident to enter into each call night predicting every imaginable catastrophe, for in so doing he/she removes each one from the realm of possibility. It's an interesting idea. I'm tempted to try it before tonight's shift, by delineating all of the ways the night could go terribly wrong. Surely then things will all be well.


Nah. I think I'll just grow the translucent beard for another day.


At 12:17 PM, Anonymous Virginia said...

Hi Ian,
It's good to see you're back again :)
I actually 'discovered' you (searching for neurology/neurosurgery-related blogs) just after your brother-in-law was killed in such a horrible way. My deepest condolences for that, and my full support for the cause of spreading the word, and making his death not a vain one.

I really enjoy reading your posts; I'm a grad student in neuroscience, and I'm thinking about going to med school, probably for neurology, but I'm also considering neurosurgery (although I wanna have a family at the same time, which, added to the fact that I'm a woman, I'm not sure makes a lot of sense, but anyway...). That's why I like knowing what kind of stuff goes on in the mind of a real neurosurgery resident... Plus, you write very well, so it's a pleasure to read you.
So yeah, I'm glad you're back on the game :)

At 9:02 AM, Blogger Ian said...

Hi Virginia,

Thanks very much for the comment -- I just noticed it was there, probably many days after you posted it! Anyhow, thanks for your kind words. Neurosurgery is a rough road, and depending upon when you ask me I'm either extremely fired up or extremely discouraged about it. If you end up in medical school and are still considering it, just be sure you try it out (i.e. try to "live it" with the same schedule the residents do).

Well, best of luck!

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