Feels like i'm back in Residency

So after graduating medical school in 98, then internship in 99, followed up with residency ending in 2007 and finally a fellowship last year, I thought I would be finished with staying up all night, doing every bit of paper work and having nurses tell me what to do.  However, I have been proved wrong.

We have six Orthopaedic Surgeons currently stationed here (although we are going down to five in three weeks as the Estonian surgeon leaves and is not replaced).  And sorry to say there is plenty of work to go around.  Our call schedule runs in six day cycles.  We number ourselves 1-6.  Number 1 runs the show, takes all the trauma, sorts out the electives and goes on rounds and meetings.  Number 2 is number 1's assistant (we call them something else, but its not safe for web blogging).  Number 3 and 4 do the majority of elective surgery on the people that get full care here - most US and British are gone after only one surgery.  Number 3 and 4 also assist with trauma if shit really hits the fan - which seems to happen about every other day.  Number 5 is the free agent and helps out where they can.  And number 6 essentially has the day off.  We essentially go straight down the line from 6 to 1 and being 2 then 1 in a row can be quite a few hours awake.

Anyway, I was number 1 last night and we had a trauma call in at 1900.  Gunshot wound the knee.  I looked at the call and thought this might be a quick one - if no broken bones then wash out the wounds and pack.  If there was a fracture then an external fixation surgery and still done quickly.  They arrive at 1910, I evaluate the wound, place a tourniquet, write the consent, order the CT scan, and write the note.  This, is what a resident is usually for (the British bring trainees over here and I am seriously considering paying for my residents to come over - no joke).  Anyway, I follow the patient to CT scan and just like residency wait with all the other services to see what it shows.  Good news, no fracture.  Bad news, Arterial injury to the main blood supply to the leg.  Now he needs a vascular repair and fasciotomies (which is basically like releasing pressure in the legs to allow adequate blood flow).  Four surgeons scrub in - my team does the dissection to find the arterial injury, gets the vein graft and completes the fasciotomy.  Then, we wait.  After the arterial repair is done - I am the only one left on the Ortho team and I place a special vacuum dressing for medevac flight.  As if this weren't the end, now I have to write the orders and surgical op note.  I get home at 1:30 in the morning.  I say this a little in jest, and I'm happy to do it and we saved the patients leg - but man I'm getting too old for this.