“No need to worry,” he declared a short while later. “This problem should correct itself as she grows. I don’t think she’ll require surgery. Please bring her back in six months for a recheck.” He fielded a few questions before doing a nimble 180 and blasting out the door, his trusty tape recorder already in hand.

As this pattern was repeated umpteen times over the course of the next two hours, it became excruciatingly clear to me that I knew next to nothing about real-life pediatric orthopedics. Eventually we took a five-minute break while Dr. Stone went down to the operating room to sort out a glitch in his schedule. When he returned he dispatched me to the plaster room to learn some casting skills. The tech was a jovial fellow with a terminal case of verbal diarrhea. He seemed to be hell-bent on giving me the entire two-year cast tech course in an hour and a half. By the time I left the clinic my head was spinning.

After lunch I returned to the ward. There I was introduced to the rest of the peds ortho team: a cranky intern and an even crankier resident. They both looked as though they hadn’t slept in weeks. Apparently the service was chronically short of house staff, and this month wasn’t going to be any different. The resident divided the ward patients between the intern and me and told us to see them, review their charts and write progress notes. The afternoon passed uneventfully.

At 5:00 p.m. we met to do sign-out rounds. When rounds were completed I picked up my knapsack and walked to the door with a relieved smile on my face. Survived my first day on the wards! Piece of cake!

“Where are you going?” asked the resident.

“Home,” I answered.

“You can’t go home – you’re on call tonight. Didn’t you see the schedule?”

My smile evaporated.

“No, I didn’t. Live and learn, I guess. Who’s on call with me?”

“Well, normally we put you newbs on with an intern or a resident, but right now we’re so short you’re going to have to take call by yourself.”

That didn’t sound too enticing.

“Who’s going to be my backup?”

“Dr. Stone.”

“Oh, that’s good.”

“Not necessarily. He takes call from home, and he doesn’t like to be contacted unless it’s for something really big.”

Oh, crap.

 

About 10 minutes after they left I was paged to the pediatric ER to see a girl with a broken upper arm. I tried to recollect what the chatty plaster technician had told me earlier about casting a fractured humerus. Something about an army-navy sling with sugar tongs. Or was it sugar buns? Whatever. I doped out a reasonable facsimile and went to town. Putting the contraption on was quite a battle – the child was developmentally delayed and she kept swinging her broken arm all over the place. I could feel the bone fragments grinding against one another whenever she moved. I had to keep reminding myself not to wince. The final product was no Michelangelo, but I was pleased nonetheless.

“Bring her to the fracture clinic next week for a recheck,” I said to her guardians in my most impressive doctor voice.

“Why does she need to come back again so soon?”

“Okay, make it a month.”

Half an hour later I was back to see a teenage wall-puncher with fractured knuckles. I wasn’t sure about the angles the various joints were supposed to be cast in, so I perused the bible – Salter’s textbook – and started slathering plaster on. The end result was a hand cast the size of a boxing glove. It was a miracle the guy could lift his arm off the stretcher.

“It’ll get lighter when it dries,” I chirped optimistically. “Come see us in the fracture clinic in a month.”

“That long?” he said dubiously.

“Okay, make it next week.”

An hour later emerg called me to see a 9-year-old with a fractured femur. Geez, isn’t that the biggest bone in the body? I scurried into the plaster room to find a stoic but uncomfortable little boy waiting for me on a stretcher. His father lunged out of his chair and shook my hand like I was the Messiah.

“I’m so glad you’re here! I’m Mr. Singer and this is my son Jake. The emergency room doctors didn’t want to give him anything more for pain until you assessed him.”

“Oh. Well… .”

“Have you had a chance to look at his x-rays yet? How serious is the break?”

“Er… .”

“Is he going to need surgery? Will you have to operate tonight?”

“Um, well, I’m not actually the surgeon. I’m the medical student.”

His eyes widened and he gasped. He looked horrified.

“When will the surgeon get here?”

“I’m not exactly sure. They tell me he doesn’t come in for every case. How about if I examine your son and then call Dr. Stone to see what he recommends?” Mr. Singer didn’t appear to be too thrilled with that plan. His nostrils flared and his eyebrows began to knit together ominously. “I expect he’ll come in right away for a major case like this, though,” I added hastily.

After the examination I telephoned Dr. Stone. I described the fracture to him and asked if there was anything he wanted me to do before he arrived.

“Oh, I don’t need to come in for that,” he replied. “Just put him in a Thomas splint and admit him to the ward. I’ll look at him in the morning when we do rounds. If you have any trouble with the splint, I’m sure the emerg doc will give you a hand. Good job! See you!”

I returned to the cast room and sheepishly notified Jake’s dad that Dr. Stone would not be coming in after all. He was not the least bit pleased. His displeasure bloomed into near-wrath as he watched me fumble around with the splint, trying to figure out how to apply it correctly. Charlie Chaplin had nothing on me. Eventually the ER doctor noticed my unintentional slapstick and came to my rescue. He also ordered more analgesics for poor Jake.

I hadn’t even started on Jake's admission paperwork when a razor-thin ER nurse with hair an aberrant shade of red stuck her head in the door and yelled in my general direction: “Hey, ortho! You better not go anywhere – an ambulance is coming in Amber Charlie Three with a girl who just jumped out of a third-storey window. They think she might have a broken back!”

A broken back? What am I supposed to do with that?

Sure enough, a minute later the ambulance attendants came bustling in with a teenager on a gurney. They had her trussed up tighter than a Thanksgiving turkey - spine board, cervical collar, sandbags, splints, tape and Velcro. The only part of her that wasn’t immobilized was her mouth, and it worked fine.

“My neck hurts! My left leg is numb! I have to pee!” she squalled at the top of her lungs.

While I was busy wringing my hands and trying not to hyperventilate, the ER doctor examined her in detail. When he was finished he came over to me and said: “She seems to be stable right now. She’s going to need baseline blood work, plus x-rays of her entire spine, pelvis, femurs, ankles and heels. She may also need to go down for a CT scan. Normally I’d look after everything, but I have to do a lumbar puncture on a septic baby and they tell me another ambulance is on its way in with a kid who’s been seizing for 20 minutes. Since this girl’s injuries are primarily orthopedic, I’m going to hand her over to you. Call in your staff guy and maybe even neurosurgery if you need backup.”

If I need backup?

My new acquisition resumed her litany: “My back is sore! My head hurts! Get me off this board!”

I was in the process of trying to decide whether I should have my brain hemorrhage now or later when the Crayola redhead poked her head through the drawn curtains and bellowed: “Hey, ortho! We have two more consults for you! And that teenager you casted earlier is back with his dad – they’re saying his cast is too tight! What the heck kind of cast did you put on his hand, anyway? It looks like a freakin’ beach ball!”