Deodorant and call

I had another all-day clinic today. Same old, same old. Systolics above 200, fingersticks in the 400s. Blah, blah, blah. I am a terrific clinic doctor...

I ran out of deodorant two days ago. I have a backup stick, which I never use, except in situations like this. This is because it was part of my "call kit", which I bought in the Monument Street Pharmacy on my third call as an intern because I realized I had left my overnight bag at home. It consisted of a stick of antiperspirant (not my regular flavor), a very cheap toothbrush, tooth floss, and a small travel-sized tube of toothpaste that was quickly used up and replaced by the Crest out of the patient supply cabinets on the wards. The Monument Street Pharmacy was never known for its amazing floor stock.

The neuroscientists teach that the reason that smell is so closely linked to memory is because the olfactory bulb projects to the piriform cortex which is on the inferior surface of the brain, in the median temporal lobes and by all the mysterious knobby bits, one of which is the hippocampus. The hippocampus (or seahorse) is a bit of gray matter that is key in formation of short term memory. Damage both hippocampi and you end up like HM (who just died) or Mr Short Term Memory or Leonard Shelby.

I suspect this is all bullshit, just like most overly simplistic mechanistic explanations of how the brain works. Needless to say, this antiperspirant brings back the post-call in a bad way.

I'd wake up around 9 AM on a call day. Into work at noon; lunch seminar if my patient load wasn't out of control. At 1 PM, the hits would start and just keep comin' just like Casey Kasem would like it, as the on-call intern is open for business for new patients from the Emergency Department. "Chart biopsy", run down to the ED, make sure the patient was as advertised, start the history and physical, and admit the patient.

As the afternoon moved to night, your fellow interns sign out their patients to you. Before you know it, you have 20 odd cross cover patients. Now your pager is going off with small fires ("Mr H hasn't got a diet order") to big fires ("Mr H isn't waking up") not only on your patients, but on the 20 odd cross cover patients that you only know in passing. And, by three months into it, it's just you. No other doctors around except your fellow first-year 'terns (unless you call in the cavalry).

By late night, hopefully you have had time to eat, change into scrubs, and maybe take a dump. Better hope for 2 of the 3. You've done the ED shuffle 4 or 5 times, maybe taken a downgrade from the intensive care unit or a day float patient. Now you try to think clearly as you formulate the all-important Plan. Go back to those 4-7 H&Ps in the corner, and actually try to 1) stamp out disease and 2) logically express those thoughts on paper in a coherent way after 14 hours on duty while 3) putting our fires and 4) recognizing that you are nearly halfway through your shift.

If you are lucky, maybe you can nap for 15 minutes or an hour if things are the unspoken Q word (it's 5 letters and rhymes with "riot"). Maybe if you are a sick freak, you can take a shower before rounds in the morning. Hopefully, you can break out the travel sized Crest and the strange antiperspirant. Change back into a shirt and tie for rounds. Most often, you'll be greasy, tired and bleary, and stinky-covered-over-with-strange-antiperspirant. Honestly, though, the teeth brushing makes all the difference. The only way I can describe intern year to a lay person is imagine working a full day, then flying to Tokyo on a turbulent flight surrounded by screaming babies, then working a full day. Do this every third or fourth night. Lather, rinse, and repeat for 10 and a half months in a year.

By morning, though, another little miracle part of the brain kicks in: the pineal gland, where Descartes thought the soul resided and by some thought to be the residual third eye. It tells your brain that since the sun is up, it's time to wake up and go on about your business. And that cocktail of melatonin, endorphins, caffeine, adrenergics, and stupidity gets you through until your shift is up at 6 PM. Or rather, usually till around 4 PM when you are working on your signout list to get ready to hand over care to the next intern.

Needless to say, 90-odd post-call days with this antiperspirant is just a wee stimulus for bad memories. It's going in the trash right after a trip to Rite Aid tomorrow.