Surgery: Code White, Part 2
January 6, 1999
Wednesday
As I mentioned in part 1, the Departments of Surgery, Orthopedics and Anesthesia were on Code White last December 31-January 1. All residents and interns in these departments were on duty, no exceptions. Roll calls were done every 8 hours to check if we were still around (and still alive). Actually, the roll calls were fun, since the whole department was gathered in one place (the surgery emergency room, or ER) and there were lots of photo opportunities. One co-intern asked me, ‘Media ka ba, o doktor?” since I had a camera strap on my shoulder instead of my stethoscope*. Haha. But this was 8 AM, and there were no patients yet, so it was quite safe to carry a camera instead of medical stuff.
Why Code White? Because of the many firecracker-related injuries, violent incidents (trauma – like stab wounds, gunshot wounds), car crashes, etc. that happen on New Year’s Eve. Although there has been a decline in the number of such incidents in recent years, it still pays to be ready. This demonstrates the power the media – before TV stations started featuring ail these broken fingers and limbs on their post-New Year’s Eve shows (around 1994-95), there were hundreds of firecracker-related injuries. Now the numbers are only in the tens. I guess these TV stations should next work on stray bullets from indiscriminate firing of guns.
To emphasize that we were on Code White, we got some shirts that said “CODE WHITE’ in block letters on the front and “TRAUMA TEAM, PGH SURGERY” on the back. We carolers got P50 off the shirt price (I paid P100 for a P150 shirt). The only way you could tell residents from interns now was by the color of the pants – if the pants were white, then the shirt-wearer was an intern. If some other color, then a resident was wearing the shirt.
We interns were assigned our posts for the duration of the Code White. I got assigned to the Special Care Unit (SCU), where major injuries were to be handled – all the trauma cases landed here. We got several vehicular crash victims, around 3 or 4 stab wound victims and 1 gunshot wound victim. Not bad for patient census, but consider that each patient had multiple injuries – which meant a lot of work had to be done for each patient. And everything had to be done on at adrenalin-rush speed: cardiac compressions, intravenous line insertions, blood extraction, vital signs measurement, etc. After being initially resuscitated, patients were sometimes sent for diagnostics like X-rays or CT scans before being brought to the operating room. Peak hours were around 10 pm of December 31 to 2 or 3 am of January 1. Most of us were asleep (uncomfortably, at the SCU of course) by 4 am. I’m glad no trauma patient came at 12 midnight as most of us were at the surgery ER for the midnight countdown. The first post-midnight patient came at 12:45 am, cutting short our revelry at the surgery ER [emergency room], as we had to go back to the SCU. We were at the surgery ER most of the time and would move back to the SCU when a major trauma case would arrive.
Note on the midnight countdown: We counted down the last 10 seconds of December 31, 1998. Once the clock read 12:00 am, we shouted HAPPY NEW YEAR! followed by 120 DAYS TO GO! [before end of internship]. That felt great!
The Surgery ER was where the minor, non-life threatening injuries were treated. These included firecracker blasts, which may or may not amputate patients’ fingers. About 15 to 20 tables were set up as mini-suturing sites, where patient and doctor would sit across each other (like a chess tournament) and w here supplies would be available (gauze, betadine. hydrogen peroxide, tape, etc.). One side of the ER was cordoned off with a sign “media up to this point only “. I don’t know if the media heeded that warning, though. The major injuries section (where I was stationed) was where ail the action took place, but the minor injuries section was where the media exposure could be found. Oh well. Can’t win them all. At least I wasn’t upstairs in the operating room or the recovery room (post-anesthesia care unit, or PACU, where the intern takes all the patients’ vital signs every hour – how boring). I was downstairs at the ER where the action was.
As for the media attention: this has probably got to be the high point(s) of the Code White duty. The reporters kept coming in and out of the emergency room. They were there at 5 AM to see our preparations but were disappointed since we weren’t set up yet. Then at around 9 AM as we were setting up, they filmed and took pictures of this, showing our “preparedness”. One of my blockmates, Q, volunteered to be a model for a newspaper photo, only to find out later that only his hands would be seen. So much for being photogenic. The first firecracker blast patient (a 15-year old) came at 9:30 AM – how early! – and was immediately interviewed by the Manila Standard. He got all the flak about getting the ‘early bird award”, and “first honor” among the firecracker people He even started to get teary-eyed. How’s that for a memorable new year.
More media coverage followed for the rest of the day. Most of us interns were media hungry, greeting everyone as the camera panned our way (I’ll bet those segments were edited out) and trying to get into every scene which the camera filmed/shot. It was fun, but I don’t think I’ll ever know the end result of all that, since I wasn’t able to watch the news December 31 and January 1. Did anyone out there get it on tape? I know some segments were shown an TV, but I don’t know which ones.
Once I was bringing a stretcher-borne patient to x-ray along with another intern and a trauma resident. A TV reporter and a cameraman followed us to the x-ray room. When we finally stopped, the reporter interviewed the patient, asking him how he got injured by the firecracker blast, and did he have any advice for other kids who play with firecrackers. Poor guy couldn’t muster anything to say. So much for his 15 seconds of fame.
And then there was a patient I was accompanying to the CT scan place across the street, for which we had to ride in an ambulance [this is called “conducting a patient”]. As I was about to ride the ambulance, this TV reporter asks me what happened to the patient, and I replied that he fell from a jeepney. “Hindi firecracker?” [not a firecracker?], the reporter said, with a disappointed look. “Hindi” [no], I answered back. Too bad.
I almost forgot the old PGH tradition, kissing rounds, which occurs just before midnight.^ My friend Emily described it as harassment without the mistletoe, but the residents were very gentlemanly about it (ok, the women residents were very – uh – gentle lady like?). Surgery and Orthopedic residents go around the emergency room complex pecking all the female staff on the cheek, greeting each one a happy new year. Some don’t even kiss every one, as they might not be familiar enough with the people they’ll be kissing. To those who are shocked, please don’t be; it was a very mild greeting.
All in all, my New Year was fun and fulfilling but exhausting. It was an experience I wouldn’t want to have missed out on, but one I wouldn’t want to go through again (except maybe for the TV greetings). I got home in the afternoon of January 1, went to sleep, and went right back to a 12-bour morning ER duty on January 2 feeling like I was coming down with a cold. And then I had another 12-hour on January 3 (overnight this time). January 4, I had a 6-hour long over-lunch operation, after which I got this systemic viral infection and was sick for two days. Talk about losing your immune resistance. I’m still trying to recover.^^
On Friday I’m off to ENT (Ear-Nose-Throat) for 2 weeks. Relatively lighter than surgery. More news then.
Notes:
* I had a camera with me as part of my efforts to document as much of internship as possible. I know I took at least one photo of myself and my co-interns during each rotation. Unfortunately I don’t know exactly where those photos are – my guess is they’re in a photo album somewhere in my parents’ house.
^ This would likely be classified as sexual harassment today. It probably was then too, but… tradition.
^^ I missed those two days of the rotation and had to do make-up duty at the ER after internship ended on April 30. That wasn’t too bad, because I (and other “super interns” making up missed time) were not the primary interns on duty. The interns from class 2000 (the medical school class after us) appreciated our temporary help.
JOINT is the Journal of INTernship, a series of email messages to family and friends (“journal subscribers”) written during my yearlong medical internship from May 1, 1998 to April 30, 1999. Internship is one of the requirements before taking the Philippine Physician Licensure Examination (also known as the Medical Boards). Journal entries were edited for clarity in January, 2020. Read more about it in the first blog post, Introducing JOINT.
