Medical Urban Legends
As medical students, we whispered about it. Residency. We had read the books: The House of God, which chronicled one young intern's loss of everything that made him human as residency beat him down. The Intern Blues and Rotations, two books that followed peds residents through their first year of internship. We knew that they had no life outside of the hospital and that on the odd time they TRIED to socialize they would commit some horrible social blunder like falling asleep at a family wedding. We knew that would soon be us. We knew that clerkship was no measure of what residency would be like. As clerks, we got called to do consults in emerg... but when issues arose on the floor, the nurses would page the people whose signature meant something... the residents. So we would often get to sleep, at least for a few hours. We knew it would get worse.
But even though we had begun mentally preparing ourselves for the stresses of residency, there were still the whispered rumours that circulated among the medical students. One surgery program in the province was allegedly known for its 100% divorce rate among it's residents. Another was notorious for putting their residents on 1 in 2 call... and submitting dummy call schedules to the union so as not to get reprimanded. We knew the stories. They were repeated time and time again as a warning not to enjoy life too much-- if would soon get pulled out from under us.
There was one story, though, that made even the most naive medical student raise an incredulous eyebrow.
"Didja hear? An ortho resident at Big Name University Hospital had a STEMI."
"He was 31."
"Dude. Swear to God. I heard it from my senior, whose staff works with the nurse who knows the guy's clerk. He almost died. Stress. Lifestyle. It's crazy."
"Heh. Does ortho let you leave at noon post-call if you have a STEMI?"
Ortho is the ironman of residency programs. Only for the hardest of the hard-core. Big men (for the most part) wielding saws, hammers and drills in the OR. Long hours, long patient lists... short marriages, and apparently, according to recent lore, short lives. An ortho resident (as is the case with most residents) simply cannot maintain a healthy lifestyle. The work week lasts 120 hours. Call is 1 in 3, and is usually without sleep. Rounds start at 6am so that they're done in time for the OR at 8am. The OR ends at 6pm, when it's back to the ward to deal with the scut. Then, if you're one of the few lucky enough to be going home that day, you're out by 8pm. Usually. Exercise? Please. Eating right? Eating at all is an impressive feat, and it's usually cafeteria fare shoved unceremoniously down the orthopod's throat while the OR is being turned over between patients. Downtime? Stress relief? You've got to be kidding me.
I was a disbeliever. I thought that residency was only as bad as you make it. I brushed aside tales such as that of the 31-year-old orthopod with the STEMI as urban legend, passed on to strike fear in the hearts of medical students everywhere.
Fast forward to the present day.
I'm sitting at the nursing station on the internal medicine floor writing in a chart. Sitting next to me is a fellow junior resident, whom I'll call Steve in a half-hearted attempt at anonymity. Steve was post-call, and was dressed in the shapeless green pyjamas that residents have been trying to pass of as real clothes since the dawn of medicine. This is significant because scrubs have short sleeves. Usually, on internal medicine, guys wear dress shirts. Long sleeves. While chatting with Steve, I happen to glance down at his exposed forearm. A prominant scar marked his inner arm, extending from his elbow to his wrist. Steve caught me staring.
"Bar fight?" I asked, jokingly.
"Yeah. I had a STEMI in my second year of residency." He said it nonchalantly, as though he told the story on a daily basis.
"Oh! I thought you were first year internal." Obviously, I was at a loss as to the appropriate response when someone catches you staring at their deeply scarred forearm. Because what year his was in was OBVIOUSLY the important thing, here. Sigh.
"I am. But I used to be ortho. I had the STEMI in my second year, when I was 31. I had to take a leave of absence, and I transferred to internal medicine. I probably wouldn't have survived ortho if I'd gone back to it."
Less-than-brilliant response aside, I am now a believer.
P.S. A STEMI, by the way, is an ST-elevation myocardial infarction. For the purposes of this story just think of it as a VERY bad heart attack. CABG is a coronary artery bypass graft (pronounced "cabbage").