Methodist Journal

FEATURED GUEST EDITOR

ISSUE INTRO

The Burgeoning Field of Cardio-Oncology

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RECOGNITIONS

Barry H. Trachtenberg Leads Issue on Cardio-Oncology

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REVIEW ARTICLES See More

Heart Failure in Relation to Anthracyclines and Other Chemotherapies

Heart Failure in Relation to Tumor-Targeted Therapies and Immunotherapies

The Role of Cardiovascular Imaging and Serum Biomarkers in Identifying Cardiotoxicity Related to Cancer Therapeutics

Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity

Cardiovascular Toxicities of Radiation Therapy

Electrophysiologic Complications in Cancer Patients

Vascular Toxicity in Patients with Cancer: Is There a Recipe to Clarify Treatment?

Future Directions in Cardio-Oncology

CASE REPORTS See More

A Rare Case of Pancreatitis-Induced Thrombosis of the Aorta and Superior Mesenteric Artery

Anomalous Origin of the Right Coronary Artery from the Left Main Coronary Artery in the Setting of Critical Bicuspid Aortic Valve Stenosis

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Do Not Pass Flow: Microvascular Obstruction on Cardiac Magnetic Resonance After Reinfarction Following Primary Percutaneous Coronary Intervention

CLINICAL PERSPECTIVES See More

EXCERPTA

Cardio-Oncology, Then and Now: An Interview with Barry Trachtenberg

POINTS TO REMEMBER

Onconephrology: An Evolving Field

POINTS TO REMEMBER

Herbal Nephropathy

EXCERPTA

Rolling the Dice on Red Yeast Rice

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

Vol 10, Issue 4 (2014)

Humanities Full Text

ESSAY ON BEING A DOCTOR

Chief Call

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Article Citation:

Hillary Patuwo. Chief Call. Methodist DeBakey Cardiovascular Journal. October 2014, Vol. 10, No. 4, pp. 264-265.

doi: https://doi.org/10.14797/mdcj-10-4-264

Through the generosity of Charles R. Millikan, D. Min., vice president for Spiritual Care and Values Integration, an annual award competition was established at Houston Methodist Hospital among the resident staff. To enter the writing competition, residents must submit a poem or essay of 1,000 words or less on the topic, “On Being a Doctor.” A committee of seven was selected from Houston Methodist Hospital Education Institute to establish the judging criteria and select the winning entries. The following is the third-place winning entry for 2014.

12:01 am. My alarm clock angrily glares at me. I desperately try to force my eyes shut and to get a wink of sleep. I nervously count, less than 5 hours before another long, grueling, 28-hour Friday shift. This call is different, though. It marks the ending of my second year as an obstetrics and gynecology resident, the beginning of being an “upper-level,” and with it comes the responsibility and honor of being “chief” on call, the most senior OB/Gyn resident in the hospital. At 4:00 pm, the harried residents impatiently wait to rush out of the hospital in mass exodus, leaving behind a skeleton crew with me at the helm. I anxiously walk the plank to meet them at “The Board,” knowing that once the baton (or in our case, the pager) is passed, my fate is sealed. No one can change what is already awaiting them, how many or which patients have been admitted. No one can know what lies ahead.

12:01 am, almost a year later. I realize that I missed the midnight countdown for New Year’s Day. I recall it was eerily quiet, and I was just about to rest my head when I was called down to assess a patient in active labor with the baby in breech position. Exactly an hour later, I find myself back in bed after declaring and performing a successful emergency caesarean section, incredulously reflecting on the amazing feat. I have gotten used to spending my Friday and Saturday nights, and some holidays, alone in the call room, drifting in and out of sleep, with my warm ginger-scented heating pad across my aching back, while my friends are enjoying the end of their twenties. Yet, I still jump at the shrill of the multiple call room phones, the vibration of my cell phone, and the high-pitched melodies of the multiple pagers weighing down my scrub pants. The only certainty of each call, whether the caller is an intern, nurse, or attending physician, is that it holds a question that only I can answer, and it demands an answer within the next 5 seconds. A few times throughout the night, I get lucky with a couple of wrong numbers, verification of orders, or dinner suggestions. Most of the time, however, I solely decide who stays and who goes, with the world watching and waiting for my decision. Often, I can actually hear someone sigh or tap their foot on the other side. At times I get really lucky and get to sprint down two flights of stairs to deliver a baby or across dark, cold breezeways to assess a bleeding patient in the emergency room. That night, I marveled at how much I had learned over the past year. I remember seeing the bay of nurses waiting for me to say “Go.” I remember watching my hands instinctively grab the knife and move at a speed unbeknownst to me. I remember looking into the eyes of the intern and medical student and seeing fear turn into awe and respect.

The following weekend I am back on call, excited to see that I inherited a patient attempting to deliver twins vaginally with one of the greatest obstetricians I have had the pleasure of knowing. All of the residents and nurses could barely contain their excitement, even after years of working on the labor and delivery unit. When the time comes to push, everyone takes their places. Being the “chief” on call, I plant myself right next to the attending, ready to assist in every step of the action. The first twin is delivered smoothly to cheers all around the room. The second twin has to be delivered quickly after, before the cervix begins clamping down. Although always composed, I notice my attending begins to struggle. Minutes pass by. I count 10 people in the operating room, holding their breaths with all of their eyes on him. Finally, the baby is delivered, but there are no sighs of relief. The baby is not doing well. Instead, murmurs and mumblings fill the four floors of our building. I try desperately to fight the waves of gossip and to steer the ship back onto course, business as usual, but I myself am shaken.

The following morning, the attending takes me aside, places a heavy hand on my shoulder, and tells me the second twin had to be transferred to another hospital for more intensive care. When he visited the mother, the father asked whether this would have happened if they had opted for an elective caesarean section, the question everyone wondered that night. My attending responded, “When you have planned and looked forward to a grand vacation, and a tragedy happens on the vacation, would you say you should not have gone on the trip at all?” He then shares with me an instance in his residency training when he experienced a string of the same complications and felt that he could no longer perform that procedure. His program director at the time then shared that advice with him.

Being a chief, a doctor, a leader is certainly not easy. No one said it would be. Yet, it is my calling. Merely 2 years ago, I remember being awestruck at the depth of knowledge and breadth of surgical skills of my chiefs, and now I am chief to the medical student delivering his or her first baby and to the residents and nurses who look to me to make split-second and often life-changing decisions. Even the simplest-appearing inquiries—whether a patient can eat or have more pain medication—can have significant implications, all of which I am ultimately responsible for defending. I have learned to lean on the gifts bestowed upon me: the swiftness of my mind, the dexterity of my hands, and the influence of my voice. Amidst the chaos and confusion, I have learned to be calm and confident, and I have learned that with difficult decisions come great rewards.