On Call: A Doctor's Days and Nights in Residency

On Call: A Doctor's Days and Nights in Residency

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by Emily R. Transue

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On Call begins with a newly-minted doctor checking in for her first day of residency--wearing the long white coat of an MD and being called "Doctor" for the first time. Having studied at Yale and Dartmouth, Dr. Emily Transue arrives in Seattle to start her internship in Internal Medicine just after graduating from medical school. This series of loosely


On Call begins with a newly-minted doctor checking in for her first day of residency--wearing the long white coat of an MD and being called "Doctor" for the first time. Having studied at Yale and Dartmouth, Dr. Emily Transue arrives in Seattle to start her internship in Internal Medicine just after graduating from medical school. This series of loosely interconnected scenes from the author's medical training concludes her residency three years later.

During her first week as a student on the medical wards, Dr. Transue watched someone come into the emergency room in cardiac arrest and die. Nothing like this had ever happened to her before-it was a long way from books and labs. So she began to record her experiences as she gained confidence putting her book knowledge to work.

The stories focus on the patients Dr. Transue encountered in the hospital, ER and clinic; some are funny and others tragic. They range in scope from brief interactions in the clinic to prolonged relationships during hospitalization. There is a man newly diagnosed with lung cancer who is lyrical about his life on a sunny island far away, and a woman, just released from a breathing machine after nearly dying, who sits up and demands a cup of coffee.

Though the book has a great deal of medical content, the focus is more on the stories of the patients' lives and illnesses and the relationships that developed between the patients and the author, and the way both parties grew in the course of these experiences.

Along the way, the book describes the life of a resident physician and reflects on the way the medical system treats both its patients and doctors. On Call provides a window into the experience of patients at critical junctures in life and into the author's own experience as a new member of the medical profession.

Editorial Reviews

Publishers Weekly
During her three years as a resident in internal medicine at the University of Washington in Seattle, Transue wrote about her patients as a way to guard against burnout and share her experiences with friends and family. This moving collection of her stories conveys vividly, sometimes painfully, the atmosphere of overwork, exhaustion and insecurity in which a resident works; the long shifts and sleepless nights, the moments when she cannot contain her tears, the times when she is haunted by fears that she has made the wrong decision. But she never loses sympathy for her patients-the heart attack victim who regrets not remembering his near-death experience, the old woman who has a pet name for her walker, the psychotic who imagines he is in constant pain and just wants her to hold his hand, even the grumpy man with emphysema who smokes two packs a day and complains about the treatment he has to receive as a result, and the habitual drunks lined up every night on stretchers in a back hallway. It's reassuring to read that a doctor isn't afraid to express compassion for her patients and that she is eager to listen and learn as they talk about their hopes and fears. There are many touching moments here, especially when she's reminded by a patient who is dying that it's important to look out the window and enjoy the view on a sunny day. Her descriptions of medical procedures can be graphic, but she presents an intriguing picture of a side of medicine many people never see. (Aug.) Copyright 2004 Reed Business Information.
Kirkus Reviews
A young physician's on-the-spot notes from her three-year residency in internal medicine, shaped into a collection of pithy, revealing little stories. The stories, which range in length from a couple of pages to a dozen, begin with the first morning of Transue's internship and end on the last evening of her residency. (She received her postgraduate training at four hospitals in Seattle.) The transformation from frazzled, uncertain intern to assured, competent physician is a long process, one the author reveals as exhausting, challenging, full of surprises, and often scary. Nearly half the stories take place during Transue's first year: it's as an intern that her experiences with patients are most intense, and it is the year in which she learns the most. Her rotation takes her through intensive care, cardiology, oncology, and the emergency room; death is no stranger in these places, and the narrative shows her growing acceptance of this fact of life. Throughout, the stories focus on patients and their conditions: the homeless man in ER who's covered in bugs; the battered young liver patient who insists that her boyfriend would never hurt her despite black eyes, bruises, and a broken leg; the teenager wanting her first birth-control prescription; the 70-year-old woman learning that her late husband had given her a sexually transmitted disease; the old doctor dying of prostate cancer. Transue intersperses scenes from her private life-nightclubbing, dancing, sailing, working out at the gym-that offer a sharp contrast to her experiences inside hospital walls and give the reader as well as the author respite from disease and dying. In her second year, she becomes a resident, with responsibilityfor interns and students as well as for patients, a role that continues in her third year. By then, the excitement has faded, but her confidence has blossomed, and she is well launched in her medical career. The perfect gift for anyone contemplating medical school.
From the Publisher

“With humor, humility, and a gentle wit, Transue leads us into the bizarre, bone-rattling world of medical training. Through her eyes, and her honest, engaging prose, we have a rare opportunity to experience the growth of a true healer. While readers may be lucky to have Transue as their guide, her patients are even luckier.” —Danielle Ofri M.D., Ph.D, author of Singular Intimacies: Becoming a Doctor at Bellevue and This Side of Doctoring

“Everyone who sees a doctor needs to read this book. Dr. Transue, through her stories, gives a realistic understanding of the pressures, perseverance and strength required for students of medicine to succeed as practitioners.” —Dr. Lewis G. Maharam, medical director for the New York City Marathon

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It was a misty New Hampshire morning, July 1994. The silence was broken by a siren, an ambulance racing toward the pretty white-and-green hospital in the woods. I was a medical student in my first week of clinical work. I helped wheel the woman on the stretcher out of the ambulance and into Emergency. I watched as her clothes were cut off and replaced with tubes and monitors. I helped pound on her chest until at last she was declared dead.

How does a person react to an event like this? I had woken up that morning having never seen a death, and by lunchtime I had been part of one. Nothing in medical school or in life had prepared me for that moment. Amid the jumble of predictable emotions--sadness, fear, confusion, a certain excitement--I felt wrenchingly and terribly alone. I had seen a heart stop, I had felt ribs break under my thrusting palms. The people I loved best in the world were not in
medicine. Would they understand what I had just seen and done? Would I be inevitably separated from them by this experience and those that would follow it?

I did the only thing I could think of. I sat down that afternoon and wrote it all down. If I could tell my mother, my brother, my friend in film school, exactly what had happened, then I wouldn't be alone. And maybe, while trying to make them understand, I would come to
understand it, too.

That first story, sent out as an e-mail, led to more stories. What began as a way of staying connected to my loved ones outside medicine became a way of staying connected to myself. Writing became a part of the practice of medicine for me, a guard against numbness
and burnout, a reminder to listen closely to each patient and to my feelings as I interacted with them. As I shared the stories, first with friends and later through publication, I discovered that my experiences, which often felt so solitary and isolating, resonated with those of other students and doctors. I was shy at first in confessing to my patients that I wrote, though I tried to ask permission when I wrote their stories down. To my surprise, patients and their families said the stories gave them a better sense of the "other side" of medicine.

I graduated from medical school in 1996, and moved to Seattle to begin my residency--postgraduate specialty training--in Internal Medicine. I was twenty-four, a few years younger than most of my colleagues, having graduated from college at twenty and gone straight through to medical school. I would become an internist, a "pediatrician for adults," responsible for all aspects of adult care except surgery and obstetrics. My residency training would last three years, of which the first, the internship year, would be the most exhausting and intense. In Seattle's program, I would rotate among four hospitals: the university hospital, specializing in the more obscure problems, the county hospital, the center for trauma
and indigent care, the Veteran's Administration or VA hospital, and a private community hospital. I would rotate among months in the Intensive Care Unit, on the general medical wards or "ward services," in such specialties as Cardiology and Oncology, and in
the Emergency Room. In general, I would spend every fourth night "on call," spending the night in the hospital as well as the day before and after. I would get four days off each month. For half a day each week during the three years, I would have my own clinic, a "continuity clinic" where I would be a primary care doctor for a group of patients. I would also have "clinic blocks," months spent in my continuity clinic and in a variety of specialty clinics, with
no weekend work or call.

By the time I started internship, medicine and writing were entwined for me. As things happened I wrote them down, scribbling fragments of conversation on the backs of my patient notecards.

Sometimes I would weave these fragments into stories right away, sometimes I waited months or years. In the most exhausting times, all I could do was keep a few barely intelligible notes. But even these reminded me to stay in the moment, to cherish my experiences, the hard as well as the happy ones, the shameful as well as the proud.

This book is a compilation of those experiences, beginning on the first morning of my residency and ending on its final night. I have tried to capture some of what I learned in those long and difficult years. Names and other details have been changed to protect confidentiality, but otherwise I have tried to render both the people and the medicine accurately.

If I had to describe my experience of becoming a physician in two words, one would be "fatigue." The mental, physical, and emotional exhaustion of this process is a theme that runs throughout this book. The other would be "gratitude." These difficult, dark years
were brightened at every point by the friends and colleagues who taught me and learned with me. The medical training system can be brutal in some ways, but the people within it are deeply supportive of each other. I am honored to have such friends. Most of all, I am
grateful to my patients and their families. I learned more from them than from anyone--medical lessons as well as life lessons. The great joy and privilege of medicine is being welcomed into people's lives in critical and quiet moments, being invited to share their stories.
It is these stories that make up this book.

A Long White Coat

Medicine is a secret society of sorts, a world unto itself, with its own language, codes, and symbols. One of the subtle but powerful codes is found in the hierarchy of the white coats. Medical students wear short coats, to the waist or hip. Interns and residents--recent
graduates in their first and subsequent years of specialty training--wear long coats, knee-length, grown-up coats. Beyond that the distinctions are more subtle; attendings--teaching doctors, who have finished training--wear classier coats, with braided cloth buttons. But the primary difference is in the length: when you become a doctor, you wear a long white coat.

For me, this was the strongest symbol of the passage into internship. More than the pomp and circumstance of graduation, with all of its glorious moments: turning to face the assembled crowd as my mentor laid a green stole around my neck, whispering in my ear, "Now you're official--"; the reciting of the Hippocratic oath; the proclamation of the dean and president, "I hereby bestow upon you the degree of Doctor of Medicine...." More than the heart-wrenching
good-byes to my medical school friends, the abrupt and painful dismantling of my apartment, packing all my possessions into a truck and driving three thousand miles across the nation. More than any of those things, what made me suddenly realize I'd become a doctor was
looking into a mirror on my first morning of work at the county hospital in Seattle and seeing my reflection in a long white coat.

Probably it's a result of years of conditioning and constant reinforcement: people in short coats are students, long ones are doctors. There are places that don't use this system, a few
hospitals in the country where interns, or all residents, wear short coats. But it's bred into me now: the long coat is synonymous with authority, with competence. The coat seems stronger than my own persona, I try to become the person who is wearing it. I notice myself adjusting my posture, my bearing, to match the coat. I occasionally allowed myself a certain frivolity as a student, which seems inappropriate in this new attire. Act your age, the coat seems
to insist. You are a doctor now.

My first morning of internship, I plan to get to the hospital an hour early, have breakfast in the cafeteria, arrive at clinic calm and settled. But the morning is fraught with delays, as I struggle
to find my stethoscope, not seen since the move, I suddenly realize, my name tag, which was in one of the two dozen envelopes I've been given in the last two days, my parking pass, in yet another envelope, my pager. I get lost on the way to the hospital, then realize I have no idea where I'm supposed to park. I arrive with just enough time to find my clinic. Five South, my schedule says. I take the center elevators, the only ones I know, to the fifth floor, step out into a corridor of small doors with prominent locks and tiny windows. In fact, I realize as the elevator doors close behind me, 5 Center is a locked psychiatric ward. There is no door to 5
South, there's no reentry to the elevator without a key, there are no staff in sight.

At the moment I become, officially, an intern--my first moment as a real doctor--I am involuntarily locked on a psychiatric ward. Despite my near tears of panic and frustration, I have to laugh at the image: I could imagine getting committed at some point in this whole residency process, but I didn't envision it happening quite this early...

Copyright 2004 by Emily R. Transue

Meet the Author

Emily R. Transue, M.D. is a native of Toledo, Ohio. She attended Yale University, where she received her B.S. in 1992 with distinction in Biology. As an undergraduate, she co-organized the D.E.M.O.S. program for science teaching in elementary schools, which received several state and national teaching awards and was featured on "Good Morning, America." She received her M.D. from Dartmouth Medical School in 1996, and was the 1996 recipient of the Pharnmacia and Upjohn Achievement Award for distinction in Internal Medicine. She did her residency training in Internal Medicine at the University of Washington in Seattle, and was then awarded a Chief Residency position, which she completed in July of 2000. She works as a general internist at a multispecialty clinic in downtown Seattle.

Emily R. Transue, MD, author of On Call: A Doctor's Days and Nights in Residency and Patient by Patient: Lessons in Love, Loss, Hope, and Healing from a Doctor's Practice, is a native of Toledo, Ohio, and a graduate of Yale College and Dartmouth Medical School. She did her residency and chief residency in Internal Medicine at the University of Washington, Seattle. She works as a general internist at a multispecialty group in Seattle, and is a clinical Assistant Professor at the University of Washington. She received the Providence-Seattle Medical Center Outstanding Educator of the Year award in 2003, and is a Fellow of the American College of Physicians. She has also published stories and poems in JAMA, Dartmouth Medicine, and elsewhere.

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On Call 4.9 out of 5 based on 0 ratings. 10 reviews.
Guest More than 1 year ago
I picked up Dr. Transue's book as my husband 'we are newly weds' is in his first year of residency. I wanted to find a way to understand what he is experiencing and be empathetic to him instead of being resentful about the days and nights he spends on call and the time at home he spends fatigued, studying and sleeping. He doesn't go into much detail about his day to day experience as I think he really wants a place that's free from the heavy weight of work. So, I looked to Dr. Transue's book to provide me with some insight about what he is facing. I get it now. This book offers vivid stories about patients and a doctor's emotional, physical and mental trials during residency. We learn about a resident's fears and their victories. I was sooo sad when the book came to a close. This is a great book for anyone as it is truly entertaining. I love that is has a glossary of medical terms in the back as well! Great read. Thank you Dr. Transue for writing about your experience.
KyleTheWolfEmery More than 1 year ago
I picked this book for a project in my English class that I had to read and I was not disappointed. I was expecting a dull book, but this book was very engaging and pulls you into it by making you feel how she felt instead of telling you. Through her story you where sympathizing for her and feeling upset and saddened when the patients in the book died.  It starts out as her becoming a doctor right after school thinking she is ready. Then she finds out that she wasn’t as ready as she once thought. Becoming overwhelmed with everything she is in charge of. Through the book she is overcoming obstacles and figuring out how to balance out being a doctor and being a person. She becomes a stronger more confident person overall. I have always wanted to be a doctor when I was growing up; I think that’s why I was very interested. I would think anyone who likes doctors, wants to be a doctor or has a close friend or family member should read this book. It gives you a good perspective on what’s going on in the hospital and what they go through every day. The only people I think who shouldn’t read this book are patients them selves. Because it tells about surgeries going wrong, patients dying, after all seems well, everything going wrong again. But on the other hand it does tell of patients going through miracles and surviving. But I feel like patients would panic and worry thinking the worst may happen to them. If these book where to be made into a movie, I would defiantly watch it. Between all the dramatic parts and the heart-warming parts, this movie wouldn’t start out strong, because I feel like the book isn’t very well known. But the word would spread and be a popular movie. Giving you the perspective of the doctor instead of the patient for once. 
Guest More than 1 year ago
I found this book absolutely inspiring. A great read and remarkably truthful.
Guest More than 1 year ago
Dr. Transue is a depleting breed of physicians that exhibit human compassion on a day to day bases.
Anonymous More than 1 year ago
The maturation of a green intern as she blossoms into a real doctor. Reading her struggled and frustrations as well as the grinding pace of intern life gives a real appreciation for the medical folks we took often thanks for granted. Written in easily digested snapshots, each one with its own way of grabbing you. Wanted more!
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Anonymous More than 1 year ago
Very insightful and engaging. As a young person looking into the medical field this memoir was extremely helpful. Beautifully written.
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