Stretching his sleepy muscles, Noah padded into the tiny bathroom buck naked. There had been a time when he wore pajamas as he had done as a child. But the habit had been abandoned when he came to appreciate that pajamas were just another piece of apparel he had to launder, and he wasn’t fond of taking the time to do laundry, as it required walking a block up the street to a Laundromat and then waiting around. It was the waiting he couldn’t abide. As a totally dedicated surgical resident, Noah chose to have little time for anything else, even personal necessities.
He eyed himself in the mirror, recognizing that he looked a little worse for wear. The evening before, he’d had a couple drinks, which was rare for him. He ran his fingers up the sides of his face to decide if he could get away without shaving until after his first surgical case. Often he shaved in the surgical locker room to allow him to get to the hospital that much earlier. But then he remembered today wasn’t a usual day, so there was no reason to hurry. Not only was it Saturday, with its usually light surgery schedule, but it was also July 1, the first day of the hospital year, called the Change Day, meaning a whole new batch of residents were beginning their training and the existing residents were advancing up the training ladder to the next level. For fifth-year residents, also considered chief residents, it was a different story. They were finished their training and were off to begin the next stage of their respective careers—everybody except Noah. By a vote of the surgical faculty, Noah had been proud to be selected to do a final year as the super chief resident who would run the Boston Memorial Hospital surgical department on a daily basis like a traffic cop at a very busy intersection. In most other surgical residency programs, a super chief status rotated among the fifth-year chief residents. BMH was different. The super chief was an added year. With the help of a full-time residency program manager, Marjorie O’Connor, and two coordinators under her, it was now Noah’s job to schedule all the residents’ rotations in the various surgical specialties, their operating room responsibilities, their simulation center sessions, and their on-call duties. On top of that, he was responsible for work rounds, chief-of-service rounds, and all the various weekly, biweekly, and monthly conferences, meetings, and academic lectures that made up the academic part of the surgical department’s program. As a kind of mother hen, he also had to make sure that all the residents were appropriately fulfilling their clinical responsibilities, dutifully attending all the teaching venues, and handling the pressures of the job.
Without the usual need to rush to the hospital, Noah opened the medicine cabinet over the sink and took out shaving cream and a razor. While he lathered his face, he found himself smiling. His new job sounded like an enormous amount of work and effort, especially since he would have his own patients and be doing his own surgery at the same time, but he knew he was going to love the year. The hospital was his world, his universe, and as super chief he was to be the alpha-male surgical resident. It was an honor and a privilege to have been selected for the position, especially since on its completion, he was assured by precedent that he would be offered a full-time faculty position. This was huge. For Noah, the opportunity to be a full-time attending surgeon at one of the world’s premier academic medical centers associated with one of the world’s premier universities was the pot of gold at the end of the rainbow. It had been his goal for as long as he could remember. Finally, all the work, effort, sacrifice, and struggles in college, medical school, and now as a resident were going to pay off.
With quick strokes of the razor Noah made short work of his overnight stubble, then climbed into the tiny shower. A moment later he was out and vigorously drying himself. There was no doubt that it was going to be a very busy year, but on the positive side he would not have any official night call, even though, knowing himself, he’d be spending most evenings in the hospital anyway. The difference was that he would be doing what he wanted to do with interesting cases that he’d get to choose. And equally important, he would not be bogged down with busy work, the typical bane of house officers or hospital residents, particularly surgical residents, since there was always some menial task that had to be done, such as changing a dressing, advancing a drain, or debriding a gangrenous wound. Noah would be able to designate others to do all that stuff. For him, the learning opportunities were going to be off the charts.
The only fly in the ointment, and it was a big fly and a nagging, persistent worry for Noah, was the responsibility he now had for the damn bimonthly surgical Morbidity and Mortality, or M&M, Conference. This conference was different from all the others, since Noah would not have the option of farming out any aspect of the responsibility to other residents. It was going to fall to him and him alone to investigate and then present all adverse-outcome cases, particularly those resulting in death.
Noah’s fear of the M&M Conference was not some irrational concern. Since the conference was specifically about cases that didn’t turn out well, often involving mistakes and individual shortcomings, blame and finger-pointing in an emotionally charged environment with dirty laundry hung out for everyone to see was the norm and not the exception. Considering the egotistical mind-set of many of the surgeons, the atmosphere could be explosive and a breeding ground for hard feelings, with the potential of creating enemies unless an underling scapegoat could be found. Noah had seen it happen over the last five years, and the scapegoat often was the messenger: the presenting super chief resident. Noah worried that the same could happen to him now that he was super chief, especially considering the Bruce Vincent fiasco. The case had trouble written all over it for many reasons, not least of which was that Noah had been involved. Although Noah had never second-guessed his decision to put the man on emergency bypass, he knew others might.