Nothing Good Happens at … The Baby Hospital

One night, the chief surgical resident of the ER was Vinnie. Vinnie had played offensive line for a division 1 football program. He was huge. I imagine there was a time where he was in shape. While he kept his strength, he clearly had spent his surgical residency eating. The largest available scrubs were stretched like spandex over his mammoth physique, to the point that when he sat, every wrinkle of his scrotum was intimately visible. Vinnie didn’t care.
When residents screw up or offend someone, they get “written-up.” Somebody tattles and fills out a complaint sheet. The resident is usually brought into the boss’s office and scolded. Residents could be fired for particularly egregious offenses. Usually, getting written-up caused significant consternation for the guilty party. Not Vinnie. The general surgery bosses’ got so fed up with the daily complaints about Vinnie, that they just accumulated them and met with him once at the end of the month.
“You insulted Nurse Smith.”
Vinnie: “That’s cause she’s a stupid bitch.”
“You insulted Nurse Jones.”
Vinnie: “She’s even dumber!”
“You can’t say things like that,” sighed the attending.
“The order clearly said to inject the heparin into the f%$*ing chest tube. She gave it IV. She could have killed him.”
“You still can’t say things like that.”
The only thing that saved Vinnie from certain dismissal was that he was really, really good. Despite his 350+ pound size, his hands were as soft as gossamer. He operated with such a deft touch, that by his chief year, the attendings recognized that he was technically superior to them in most surgeries. Once, Vinnie scheduled a very complex chest case that he had never done before. The patient was prepped and asleep, but the attending, for whatever reason, didn’t show up. Vinnie broke out a textbook, read for a few minutes, and then perfectly performed the case.
On this night, Vinnie was sitting at the main control desk in the center of the ER. He was joking with the nurses and medics who, in the ER, all loved him.
“Woah! Look at that dude! He’s totally f-d up!” Vinnie bellowed as the medics brought in a drunken trauma patient. The younger surgery residents descended as Vinnie watched, much like a dad would watch his kids play football. Every now and then, he’d shout out an instruction, then go back to gabbing with the nurses.
The patient had a laceration across his thigh that was about a foot long.
“What’s your name?” Vinnie demanded.
“Dan, sir.”
“Sir?” Vinnie and the nurses laughed. “Sir? I’m sitting in a shit hospital, looking at a shit drunk asshole, at 1 in the morning. Think any “sirs” do that?”
“No sir!”
Vinnie couldn’t tell if I was hopeless or a smart-ass. “Go sew that dude’s leg up.”
OK, I can do this. This is a medical student’s dream! The guy was moaning loudly despite having a breathing tube down his throat. I looked for numbing medicine. There was none to be found.
“You done yet Dan?”
With my pediatric surgery training under the gaze of the stern leopard scrub nurses, I felt like I was a master at cleanliness. Hmmm. Cleanliness was going to be hard with all this blood and, oh no, poop all over the place. I took off the bandage. The wound started to bleed.
“It’s bleeding.”
“No shit?” Vinnie yelled from his seat without looking up. “Maybe someone should sew it up.”
I cleaned it, put on a gown, then rushed to the sink to meticulously scrub my hands before donning sterile gloves. I scrubbed and scrubbed. I became aware of a giant shadow behind me.
“What are you doing Dan?”
“Scrubbing si- , I mean Vinnie.”
Vinnie nodded, then stood motionless as I finished, double-checked that I didn’t have any more cooties on me, then slowly followed the ritual to sterilely wear gloves.
“Very nice Dan, I’m impressed.” Vinnie nodded approvingly. My heart soared!
“Thanks!”
“That was great scrubbing. Just f-ing great. Now – contaminate yourself.”
“What?”
“Contaminate yourself. Get your hands dirty.” The nurses elbowed each other and giggled.
“Here, I’ll help.” Vinnie took my pristine gloves and wiped them on the bed and on the patient’s non-cleaned leg. I was aghast but helpless.
“This guy was lying in a ditch for about 2 hours, drunk off his gourd. There’s no way his wound is clean. You did a good job removing the dirt, but his wound is contaminated. There’s no way to make it clean. Right now, he’s losing blood. He needs the wound closed. We’ll put him on antibiotics. Wash it out and sew it up. NOW.”
Later that night, one of my classmates was called to help a junior resident debride a diabetic rectal abscess. A diabetic rectal abscess is a painful collection of bacteria and hatred, nestled tenderly in an obese person’s butt.
It’s the foulest smelling thing on earth.
Imagine a combination of vinegar, rotten eggs, and dead birds. Then take a deep breath and enjoy that intoxicating aroma because that’s a rose petal compared to a diabetic rectal abscess. It smells like diarrhea mixed with evil. And the abscesses are horribly painful.
For obvious reasons, the lowest ranking providers are sent to deal with it. In this case, the patient long passed the 400-pound mark. He could barely move. My classmate’s job was the noble task of holding open the butt cheeks.
“OK, you’re going to feel a stick, then it should feel better,” the junior resident said. My friend braced himself.
The treatment of an abscess is the advanced, modern technique of sticking it with a knife. Experienced residents sit to the side. This resident did not.
“OOOOOOWWWWWW!” the patient yelled.
My classmate used a leg to brace open the butt.
The reason the experienced resident sits to the side is that the foul vomitus pus is under pressure – a lot of pressure. Power-wash pressure. Pus squirted out, dousing the resident in a yellow white shower of hell.
My classmate, losing his battle in ass-spreading, saw the mess, smelled the smell, and promptly vomited. His heave was mighty and, because of his position standing over the resident leaning into the ass cavern, most of the puke hit either the patient’s or the resident’s leg.
“What the …” the patient said, feeling the splatter. He could smell the stench and feel the warmth of puke. So he started vomiting. This made the student vomit again. This made the patient vomit again.
Dear God…
Vinnie looked up from his magazine. “What’s going on in there?” An old nurse sitting beside him sighed deeply. She paged the janitorial service, knowing that they would rush to the scene as soon as they darn well felt like it.
Sam sidled up next to me. “Isn’t this great?!”
He was serious.