Noah gave him the finger and an exaggerated dirty look.
Still with time to spare before general work rounds would begin, Noah used the phone in the nurses’ station to call the OR to see if anything had been scheduled behind his back. He had checked the evening before, prior to the Change Party, and had been told no surgeries would be scheduled until 10:30 A.M. His concern was that if surgeries had been scheduled overnight, which needed resident helping hands, it would be up to him to supply them. He was happy to learn that no cases had been added. For once, word had apparently gotten out so that the entire surgical department knew about the welcoming ceremony. Noah was pleased on one hand and a bit more nervous on the other. The implication that the ceremony might be even better attended than usual added to his anxiety about speaking.
Noah next went around to check in on his three private patients whom he had operated on. He thought it important for him to visit each at least twice a day to have direct, personal, face-to-face contact. Though he would see them again on work rounds, that was different, as it would be with the whole resident team. Noah had never been a patient himself, but he was sure that if he were, he’d want to have a few private moments with his doctor every day. His attitude about the importance of communication was one of the many reasons he was so popular.
Two of the three patients were still asleep when Noah entered their rooms, and Noah had to wake them up. During his first couple years as a surgical resident, Noah would not wake patients, thinking he was doing them a favor by letting them sleep. A dressing-down by a patient made him change his mind. Patients truly valued the personal, one-on-one time.
All three patients were doing fine, with one scheduled for discharge that afternoon. Noah spent a little more time with him to let him know what he could and could not do. He also assured him that he would see Noah and not another resident in the clinic for follow-up. The man had been a patient of the BMH for years and knew the ropes. Sometimes when residents rotated onto different services they didn’t get to follow patients they had taken care of on previous rotations. Noah had always made sure that didn’t happen to him. It was one of the benefits of the sheer number of hours Noah spent in the hospital, which married residents with families simply couldn’t do. Noah was never bothered by this added effort; in fact, he thought the opportunity gave him a leg up.
Work rounds went especially smoothly for a number of reasons, primarily because there were no problem cases that needed extended discussion as to future course of action. Another reason was that it was Saturday, when it was rare for attending surgeons to show up and try to turn work rounds into a variation of chief-of-service rounds, whose goal was teaching or at least pontificating. Work rounds, by definition, were a time to merely review the chief complaint, what had been done so far, and what was going to be done that day or in the near future, and then move on to the next patient.
The final reason the work rounds proceeded apace that morning was that the junior residents who did the actual presenting were now all second-year residents and knew the ropes. Presenting cases was a learned skill, which all had mastered, except for Mark Donaldson, who was obviously either not prepared or, worse yet, had somehow failed over the year to grasp an appropriate sense of what was important and what was not. Noah spared him the embarrassment of calling him out on the spot, which had been a typical pedagogical surgical-rounds teaching method honed by some attendings to the level of torture. Noah had hated it when he was a junior resident, even though it had rarely been directed at him. Nonetheless, Noah had vowed never to do it as he rose up the ladder. With the belief that persuasion was a far better teaching method than ridicule, he planned to take Mark aside at some appropriate time, probably later that day, and have a heart-to-heart discussion.
Since it was Saturday and there were to be no chief-of-service rounds, Noah had a bit of free time. The welcoming ceremony wouldn’t commence until 8:30 and it was now 7:00. After reminding all the other residents about attending the welcoming ceremony and after entering his progress notes on his three patients in the electronic medical record, or EMR, Noah took the elevator down to administration on the third floor.
In sharp contrast with the rest of the hospital, which operated on a 24/7 basis, the administration area was all but deserted on a Saturday morning.
Noah’s destination was the surgical residency program office, which was at the far end of a carpeted hall where all the graduate medical education offices of the various specialties were located. When he got to his office door he fished out the lone key he had in his pocket. It had been dutifully handed over to him a few days ago by Dr. Claire Thomas, the outgoing super chief responsible for shattering a few significant glass ceilings. She had been the first African American woman to be the BMH surgical super chief and was, as of that very day, the first African American woman on the BMH surgical faculty. Noah knew she was going to be a hard act to follow, as everyone liked and respected her, including Dr. Mason. She had never been chastised in front of the Residency Advisory Board by the program director, Dr. Cantor.