Ashley's Bio

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If you go to the dark basement of our teaching hospital and wind around turn after turn, you will eventually encounter a small hallway with a door. The door is heavy and wooden with a small orange sticker depicting the familiar intertwined shapes of the biohazard symbol. There are always garbage bags and linens outside the door, just like any other place in the hospital. Next to the door is an old, shabby elevator which is usually open. I can vaguely recall this same elevator being outside our gross anatomy lab up on the 7th floor. Late one night, I watched a man roll a stretcher completely covered with white sheets through the door. A soft outline of a body could be seen.

Just down the hall from the morgue is a small place I learned to call home earlier this year: the girls' lounge. It has 3 small rooms: one with a couch, one with four beds, and a bathroom. This was to be my call room during surgery call nights. Alone in the basement, not counting the roaches. Just me and my pager. Now I had been to the lounge in the day with my friends to share lunch and swap gossip. Maybe for a quick nap between clinical duties or a 30 minute cram session before a test. But never alone and never at night.

Our surgery rotation has overnight trauma call that varies from every third night to every sixth night, so I knew I would become well-acquainted with this room. So, walking around it, I wondered. Would I get to sleep here at all or would I be in the ER seeing patients? Would I have time to take a shower down here? Being new to surgery and new to overnight call seemed overwhelming. So, I started out on surgery as scared about call, scared about the morgue down the hall, scared about the residents & well, just scared.

My first night of call proved to be eventful. I spent a few hours doing floorwork & following consults in the ER. All of a sudden, the trauma pagers sang in unison. GSW to the chest! We raced to the ER to find a young black male being brought in. We quickly dressed in masks, gowns, and gloves. I and another M3 grabbed our papers and tried to sketch together the details of this young man's evening. While we were trying to get a family history or another unimportant detail, we realized exactly what was happening. They were shocking this guy! He wasn't breathing & his heart wasn't beating. Wow, this is it. A true ER moment, just like with Dr. Carter! But, not really. The attending stood at the door and shouted a handful of instructions. 5 residents fumbled around the patient. Curse words flew. Finally, someone cracked the guy's chest. His technique was doggedly criticized. He grasped the man's heart and slowly squished it between his fingers. More cursing…I saw my first and only open-chest cardiac massage that night. Then it was over. Wait, on TV, this lasts forever. On Trauma: Life in the ER, they bring people back all the time. Right? Well, not here. The attending was already gone when I looked up again. I had a history form clutched in my gloved hand. I looked at the other M3. "What do we do now? Do we still fill this out?" "Who knows," he replied. So, we tossed it. We didn't know the guy's name, his age, what had happened to him, or anything really. Just that he was dead.

We surveyed the room after the residents fled the scene. The ER nurses were busy picking up needles and trash that had fallen to the ground. The man's clothing had been hastily ripped and cut off of him and was hanging off the stretcher. He looked to be a little younger than me. Lying nude on the table, he looked cold and vulnerable. IV lines formed a highway, crisscrossing his chest and arms. His socks had Hanes spelled across the toes, just like mine. His chest was bloody and opened, distorting the intricate tattoo embellishing his torso. And he was my first dead patient.

By 2 am, I retired to the basement for sleep. As I rounded the corner and passed the morgue, I thought about the patient I had just seen. How odd that he was probably at home earlier tonight and will now be down here in the basement with me. But what affected me the most was how it didn't affect me. I just watched a guy die right in front of me. Nobody else seemed bothered by it, so why should I be? Maybe I learned this behavior from the residents or maybe it is just part of the coping mechanisms you develop throughout your career. Anyway, I was so exhausted that I didn't want to think too much about it. I decided to lay down on the firm mattress and contemplate sleep. Eerily, all I could think about was this patient, plus the roach I had seen earlier and the fact that dead bodies were just down the hall! And how my husband was at home in the bed curled up with my kittens. It took nearly an hour before I fell asleep, only to rise for the next day 2 hours later.

The weeks crept by. My call schedule steadily marched along, filled with scutwork and middle-of-the-night pages to the ER. But, gradually, I replaced my fears with the confidence that only experience can bring. I mastered the paperwork necessary for working up trauma patients, learned a few procedures, and witnessed some amazing operations. But what stayed with me the most was how taking call for surgery changed my opinion of cynicism in medicine. How cynical you can become when you see patients who are repeatedly stabbed or shot. When a patient comes in with a gunshot wound and you are unable to tell on x-ray which is the bullet from last year and which is the bullet from tonight. When the patient is well-known to both ER and trauma staff for their history of multiple injuries. Drunk men who hit their wives. Drug deals gone awry. Alcohol and drug abuse. Gang-related injuries. How sad it all can be.

By the end of surgery, I knew that is wasn't for me for a lot of reasons. Trauma call was one of them. I couldn't imagine being confronted with these situations every third night for five years. Looking into the eyes of death night after night, sometimes winning, but often losing. Sending patient after patient to the morgue. Patching a patient up only to see them again weeks later after a shooting. And, becoming even more desensitized to the rampant violence and crime in our city and state. I developed a newfound respect for those who are surgeons and do it well, especially trauma. And I learned that a happier field would be best suited for me.

As for the lounge, I went by this week with a group of friends. Several overnight bags were stashed on the beds. I quickly gave thanks that I was finished with that call schedule and being exposed to an ugly, violent part of society. We all entered medicine to help our patients, to see them get better from illnesses and help them to evade death. And I remembered that there are many patients that we can't save. Those who, sadly, it seems are destined for the morgue.

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*Some names have been changed.