flying or driving to that hospital to procure the organs. Otherwise, the
intern’s role on the transplant team is to manage the peri-operative
patients, minimizing the chance of organ rejection while trying not to
accidentally kill patients. When it comes to intern competence, this is a
real threat.
The demands of call on the Plastics service are so minimal that I am
allowed to field the phone calls from home, a welcome luxury after eleven
months of in-house call, usually taken every other night in thirty-six-hour
shifts. Now I am only working twelve-hour days, and only taking call every
third night. My work week has been reduced to less than eighty hours per
week, and I am loving it.
This being Sunday evening, the only real threat to my night blowing up
is a fresh surgical patient suffering a wound dehiscence (skin separation)
or infection. We are not on for hand emergencies tonight (it’s Orthopedics’
turn), and I admit it: I’m almost gloating about the great night of sleep I’m
about to enjoy.
My Motorola pager buzzes next to me—it’s the ER. Dang it. I dial the
main number to the ER on my PalmPilot phone, and after a brief hold, a
familiar voice greets me.
“Dr. Schneider, this is Paul from Infectious Disease. We were called to
see a forty-four-year-old AIDS patient who I’ve seen in the past. He’s been
HIV positive for seven years, but his meds aren’t working very well. His
cell counts are pretty low, and now he’s got this bizarre skin infection.” (In
1996, being HIV positive was still a death sentence. The anti-retrovirals
were in their infancy, and patients still were dying from AIDS after
prolonged illnesses.)
I respond, “What do you guys want us to do?”
Paul says, “I talked to my chief, and he told me to call Plastics, to have
a look and see if you should do surgery and cut these fungus balls out of
his arms and leg.”
“Fungus balls?!?”
“Yeah—we think it’s subcutaneous phaeohyphomycosis, where fungi
from the environment invade the bodies of immunosuppressed patients,
growing into large colonies under the skin. Can you come to the ER and
take a look at this guy?”
Scrambling for power, and trying to figure out my role in this strange
story, I ask the classic question any intern must ask. “Why Plastics and not
marcin
(Marcin)
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