Chapter 40: Doctor Saunders Is in Good Company

July 14, 1990, McKinley, Ohio

"How are you doing?" Isabella asked when I arrived in the ED just before 5:00am on Saturday.

"After yesterday, I needed another three or four hours of sleep, but I'll be OK."

"I saw your list of patients; that was a day from Hell, for sure."

"My exact words to my wife," I replied. "Let me go see Mary and have her run the board for me."

"What? An Attending can't tell you?"

I chuckled, "Usually? No. Keeping track of the board is a Resident's job, not an Attending's job."

Isabella laughed, "True, but I bet you don't agree with that."

"I don't. All of us should be aware of what's on the board because you never know what might happen."

"You might change your opinion when you're an Attending, though, knowing you, you won't."

"What's on the board, Doctor Mastriano?" I asked with a grin.

Isabella laughed, "Non-STEMI with inverted T waves suggesting myocardial ischemia waiting to go up to Cardiology, probably around 8:00am when they get their thumbs out; MVA with mild cervical acceleration-deceleration syndrome being observed until 7:00am; teen with nasal bleeding due to excessive insufflation of tropane alkaloids waiting on admission to Psych."

The latter two were 'whiplash' and 'snorting coke', but she was teasing me by using more medically sound terms.

I chuckled, "You did that on purpose!"

"Of course! We Attendings do know a bit about medicine, even if you Residents think we forgot it all and put our feet up while you work!"

"I'm going to plead the Fifth on that one!" I said piously. "Let me go speak to Mary."

I walked to the triage desk where Mary was supervising.

"Morning," I said.

"Morning, Mike."

"How was overnight?"

"A steady stream, but not overwhelming. There are only three left — non-STEMI waiting on Cardiology; whiplash being observed until 7:00am; seventeen-year-old with a coke habit serious enough to induce nasal bleeding waiting on Psych."

"Where does a seventeen-year-old come up with the kind of cash you'd need for that?" I asked.

"Wasn't your friend the school teacher a millionaire at age sixteen?" Mary asked.

I chuckled, "Point taken. Who saw him from Psych?"

"Maureen Bishop."

"Good. She's quite the breath of fresh air for that service. Anything in the rack?"

"No."

"Then let me go find my students," I said.

I stopped to check the board, then went to the lounge to find my Saturday students — Marissa Landscomb, a Fourth Year, and Taryn Jacoby, a Third Year.

"Morning, Marissa; Morning, Taryn," I said.

"Good morning, Doctor Mike!" Taryn said brightly, flashing her usual winning smile.

"Morning," Marissa replied, in her usual grumpy way.

Their two personalities were almost opposite, and both were good students, though Marissa was the better of the two. Stereotypically, at least for her personality, she wanted surgery, which I felt was a good fit. Taryn wanted pediatrics, and I felt her personality was a good fit there.

"Quiet night last night, I hear," I said as I poured myself some coffee.

"I sutured a forearm lac," Marissa reported. "Eight sutures. One MVA that went up for surgery; passenger is waiting on discharge for whiplash."

"What's the technical term?" I asked.

"Cervical acceleration-deceleration syndrome, though literally nobody calls it that."

"Doctor Mastriano did when I asked her to run the board," I replied with a smile.

"She had to be yanking your chain, right?" Taryn asked. "She called it 'whiplash' last night."

"She was. She also said the coke addict had nasal bleeding due to excessive insufflation of tropane alkaloids."

Taryn laughed, "Seriously? THAT is how you report snorting coke?"

"She was technically correct. Do you remember the footnote in your textbook about the technical term for oxygen by nasal cannulae?"

"No."

"It's O₂ insufflation."

"Isn't the plural usually 'cannulas'?" Taryn asked.

"Yes, but I took several years of Latin, and it's fun to say things correctly, such as having more than one locum tenens is having several locum tenentes. In English, we usually simply say 'locums', though that is technically incorrect."

"Don't we do that with Greek and Latin all over the place in medicine?" she asked.

"Yes. I notice more than most because, in addition to several years of Latin, I taught myself Koine Greek."

"The New Testament language, right?"

"And the official Orthodox Christian Old Testament, which is the Septuagint as opposed to the Hebrew Masoretic Text."

"But weren't they originally in Hebrew?"

"Yes, but it's not that simple, and please excuse the brief theology lesson. The Greek version is older and more well attested in antiquity than the Masoretic Text. The Orthodox Church uses the Septuagint, as I said, while the Masoretic Text is the basis for the translation in most Protestant Bibles.

"The earliest fragments of the Masoretic Text are from the ninth or tenth century, while the Septuagint texts we have date from the fourth or fifth century. It's important to remember, too, that Paul, the Apostolic Fathers, and the Greek Church Fathers all quoted the Septuagint in the first, second, and third centuries. And, finally, the Gospels make use of the Septuagint for all their references, except for a few Aramaic citations."

"Things my pastor never told us," Taryn replied.

"There are also more books in the Septuagint, which is why our canon is larger than the Protestant one. They were removed by the Reformers."

"Doctor Mike?" Nurse Jamie said from the door to the lounge. "Doctor Mastriano needs you. Paramedics three minutes out, bringing in an MVA, semi versus car."

"Semi wins," I sighed. "OK. Marissa, Taryn, let's go."

We left the lounge, put on gowns, goggles, and gloves, and headed for the ambulance bay.

"How many victims?" I asked Isabella.

"One."

She gave assignments, and the paramedics rolled up about a minute later. The single victim had been the passenger in the car, which had run a red light and been t-boned by the semi on the driver's side. We quickly moved the fifteen-year-old boy to Trauma 1.

"Are we getting anyone else?" I asked Tom, the paramedic.

"The driver was crushed in the car; the truck driver refused transport."

The patient was severely injured, but had no immediately life-threatening injuries, and wasn't a surgical case, so once we had him stabilized, my students and I returned to the lounge.

"Doctor Mike," Marissa said, "what's with the black surgical cap?"

"A personal style choice," I said. "The default is red, but every PGY2 in surgery and PGY1 in trauma surgery is permitted to select their own personalized colors. Surgeons usually don't wear them in the ED, but mine has a pocket for my ponytail, so I wear it full-time. Mary Anderson has yellow and gold ones, but doesn't wear them full-time."

"Why don't we wear masks?" Taryn asked.

"They're optional," I replied. "A few doctors do wear them regularly, but most of us prefer patients to be able to see our faces. The exceptions are for infectious diseases and burns, where some staff will wear masks with a bit of Vicks VapoRub smeared on them."

"Because of the smell?"

"There is nothing even remotely approaching the smell of burnt flesh," I replied. "In any event, if you feel wearing a mask is warranted, please do so. Nobody will say a word. I suspect, at some point, they'll be made mandatory, like gloves and goggles, though they may go the NFL route and grandfather Attendings the way the NHL did with helmets."

"I thought they were mandatory," Taryn said.

"They are, but any player who entered the league before June 1, 1979, could opt out if they signed a waiver. There are still a few players who play without them — Al Secord of the Chicago Blackhawks, who just retired, was one. Guy Lafleur of the Quebec Nordiques is still active and plays without a helmet, as does Craig MacTavish of the Edmonton Oilers. There are a handful of others."

"I'm going to guess you're a hockey fan."

"I follow the Penguins, and watch games occasionally on TV, but unfortunately, there hasn't been a pro team in Ohio since the 1979 NHL/WHA merger when Cincinnati lost its pro team, the Stingers. Mark Messier played for them before Edmonton signed him following the merger."

"Things I didn't know. I'm from Bloomington, Minnesota, so I'm a North Stars fan."

"Then we're both in the same boat with teams that had lousy years."

"For sure," Taryn agreed.

"On a positive note, the Reds are twenty games over .500 and are having a great year, and should make the playoffs, though I was worried back in April about the lockout possibly wrecking the season."

"The Twins should have a decent year, but they aren't the '87 Twins," Taryn observed.

"And the Reds aren't the Big Red Machine, but there you go."

"Would you play hockey without a helmet?" Marissa asked.

"No, just as I wouldn't ride a motorcycle without a helmet and proper gear, or ride in a car without fastening my seatbelt."

"Mike?" Mary asked from the door. "Can you take a walk-in?"