This month of my intern year, I am covering night float for the private hospital. Compared to the massive county hospital teeming with laboring patients, churning at all hours of the day and night, the private practice pace is meant to be a luxury for interns seeking respite. And for the most part, life has been pretty nice.
This week however, has been nothing less than hell. One night, I was called to the bedside of a postpartum patient with difficulty breathing. After a brief physical exam and a glance at the chest x-ray it was clear that she had a massive amount of fluid on her lungs needed urgent diuresis. When her clinical situation was not improving, I decided that she needed to be transferred to the intensive care unit. As her bed was wheeling down the hall for the transfer, another post-partum patient had a medical crisis and a code blue was called. She was also promptly transferred to the ICU. (Thankfully, both patients are fine now.)
I was blessed to have a high risk obstetrics fellow in the hospital with me that night, and she helped me immensely. However, as the second patient was rapidly transferred upstairs, she pointed at me and very sternly exclaimed “You are a black cloud. I have been working at this hospital for six years and I have never had a night like this.” As it turns out, ICU transfers on the obstetrics service happen about twice a year, not twice in one hour.
Medical professionals, however evidence based they aim to be, are extremely superstitious. It is common belief within medicine that certain doctors carry clouds, black or white. Simply put, a black cloud harbors disaster. When a black cloud is on call, bad things happen; the heavens open wide and storm emergencies and rare negative outcomes. White clouds float gracefully through their medical training. Nights are quiet and restful and patients behave themselves.
I was oddly devastated by the black cloud label. At an already grueling training program, can I handle the pressure of knowing that I will accompany catastrophe? Fortunately, black clouds among residents have been studied. In a 1993 study, a group of 19 pediatrics residents were followed for one year comparing those who had self-labeled black and white clouds. On average, the black clouds had no more admissions, deaths, or other adverse outcomes than the white clouds. Simply the perception of workload and stress kept some residents pacing the halls at night while others slept peacefully.
Certainly in residency we all have bad nights. I have decided that I will not self-label as a black cloud, because I believe that it will jade the way I view my work. I don’t want to dread going into the hospital, and I don’t feel like carrying the blame for random occurrences that happen to walk through the door. Even if I do truly have a black cloud, I think that residency is an excellent time to have one. The more exposure to challenging situations I have in my training, the better I’ll feel when I’m the attending, alone and in charge.
What happened the night after the ICU catastrophe? Two women had placental abruptions, a rare and extremely serious obstetrical emergency and required stat C-sections. Maybe it is storming right over my head.
Elizabeth Breuer is an obstetrician-gynecologist who blogs at OB Cookie.
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