Random Thoughts from a Restless Mind

I have been on call this Holiday weekend for my private eye care practice, SkyVision Centers. I no longer cover hospitals or ER’s. It’s been about 5 years, I think, since I’ve had a call from an ER doc or a request to do an in-house consult. T’was a time when all private docs did so. For free. The Affordable Care Act put an end to that. As things would have it my last weekend of call was 4th of July weekend 5 years ago, since then relieved of the duty 2 years earlier than the age 60 reprieve written into the medical staff bylaws. Even so, I remember those days, and I remember especially what it was like to be on call on the 4th.

What follows is from my older series “Tales from Bellevue Hospital”, a memory of what it was like to be a resident on call in the “old days” at Bellevue Hospital, NYC.

Bellevue, at least the Bellevue I knew in the 80’s, was quite a different story. Although it was July it was July in New York, pre-Guliani New York, and it was Bellevue Hospital.

There are only two kinds of people in New York City: Targets, and people who hit Targets. At Bellevue we took care of the Targets.

It’s the first weekend in July. For most people in America that means the 4th of July and everything that goes along with that. Barbecues. Fireworks. Festivals and ballgames of all sorts. And beer. Lots and lots of beer. But in that curious sub-culture of medical education the first weekend in July means the first time on call for newly minted interns, newly promoted residents and fellows of all sorts. Everyone and everything is new, just in time for July 4th and its aftermath.

Funny, but I ended up on call for every 4th of July in my four years of post-med school training. I’m not sure which, or how many, of the residency gods I offended, but whatever I did I apparently did in spades ’cause I hit the first weekend jackpot every year. I have no memory of my first on call as an intern, but the “Target Range” was open for business those first couple of years at Bellevue, for sure! In fact, if memory serves, the phrase “Target” was coined by yours truly that very first weekend of that very first year as an ophthalmology resident.

“Hey Eye Guy! We got a John Q. Nobody who got shot in the temple just standing on the subway platform. Says he can’t see. Whaddaya want us to do with him? By the way…welcome to Bellevue.”

Crowds and beer and heat and stuff that explodes. Welcome to Bellevue, indeed. Some poor schlub survives the bar scene after the parade, makes it through pickpocket alley intact, gingerly stepping over detritus living and otherwise, only to get shot in the head as the A Train approached the station in a random act of anonymous violence. The bullet entered through the right temple, destroyed the right eye, and wreaked havoc in the left eye socket before coming to rest against the left temple. Right eye gone and malignant glaucoma in the only remaining left eye. And there I was, all of 3 days into my opthalmology residency, backed up by a chief resident of similar vintage. Whoa…

There’s no way to avoid it. After all, med students have to graduate and residencies have to start some time. There’s just this unholy confluence of weak links in the system all coming together in time for the second (after New Year’s Eve) most difficult ER day in our big, academic hospitals. Get sick or injured on June 4th? Everyone’s on top of their game and everyone’s in town. July 4th? The fix is in, and the game is as rigged against you as any carnival game attended by a dentally challenged carnie.

As I sit here, an Attending on call for yet another 4th of July weekend, covering the ER and cowering each time the phone rings, the Tweets and Facebook posts heralding the arrival of a new crop of interns and residents send me back to Bellevue. Year 2, cursed again, covering the spanking new 1st year ophthalmology resident (was it Dave?) as he got his welcome “gift” from the ER. “Hey Eye Guy. We got a Target down here for ya. 10 year old girl. Some dumbass tossed a lit M80 to her and she caught it. Went off before she could get rid of it;  blew off her right hand and looks like her right eye is gone. You from NY? No? Welcome to Bellevue, pal.” Yup…there’s something about the 4th of July in every teaching hospital in the U.S., and just like everything else, whatever it is, there was more of it at Bellevue.

Only two kinds of people in New York, Targets and people who hit Targets. At Bellevue we took care of the Targets.

1 Chukker. A period in a Polo match. Typically 4-6 chukkers per match.

At the moment I am watching my first ever Polo match on ESPN.

2 Chucker. A Cricket player who throws the ball illegally.

Unsuccessfully channel surfed trying to find a Cricket match.

3 Chuckin’. For 99.999% of people on FB, Twitter, Instagram, etc., posting your political views in the hope that you will somehow create a tectonic shift in public policy is roughly akin to attempting to change the tides by shooting the waves with a squirt gun.

4 Chucked. We downsized 10 years ago. 50%, give or take. One story, although there is a tricky slope in the backyard to get to the liquid playground beyond. While I try to downplay our good fortune at finding Casa Blanco, I never miss an opportunity to extol the virtues of one floor and a smaller footprint. I bump into more and more people contemplating a similar move, although no one is quite as bold as Beth when it comes to the magnitude of the downsize.

Maybe because we always point out that you gotta chuck everything you can’t fit into your new home.

While shopping for our next adventure this afternoon we bumped into the owner of the outdoor shop we frequent who told us that he and his wife just did a rather big downsize as he prepares to retire next year. His one fear as they get ready to make the move? Where to put all of his stuff! His mom’s basement is still full of his dad’s stuff, and Dad has been gone for 10 years! Unlike Beth he is of the mind that one must curate your stuff, all of your stuff, so that you are sure that the stuff you don’t keep is truly unnecessary.

Not Beth. Oh no. She’s done this for three households now. One quick look and then she just chucks it!

5 Friendship. Gotta move on from the “chuck theme”; only one lift I could think of was upchuck, and my CrossFit WOD wasn’t bad enough to bring that up. (See what I did there?!) I’m prompted to return once again to one of my favorite topics, friendship and friends. This week saw the 5th anniversary of the passing of one of our Williams email thread buddies, Starsky. He was one of the kindest men I’ve ever known. I was really maybe a borderline second ring guy for him, but it still stung to lose him so young. He was the kind of guy who would move a mountain for a second ring guy. Do the kind of stuff that “regular friends” would only do for first ring friends. Maybe only inner circle, best friend; there are guys like that, too.

Professor Robin Dunbar posed that the maximum number of individuals with whom a human can maintain social cohesion is 150. Hence, “Dunbar’s Number”. Essentially “social cohesion” means that you have some degree of awareness of who another person is beyond simply their name and their Twitter handle. Further research seems to show that we can follow 500 acquaintances (we know a bit more than just their name; for example, we might know to whom they are married), and we can match some 1500 faces to names. As I’ve written before we then cone down through various circles (friendly acquaintances, casual friends or “buddies”, close friends, and best friends), and there is a nearly constant movement in and out of all but the closest inner circles.

Best friends, close friends, casual friends, friendly acquaintances, people you’ve met. The rank order of friendships. If my Dad said it once he said it a couple hundred times: if you have one true friend you are one up on most of the world. I am blessed to have two men who are best friends in addition to my brother, my very best friend, and my 4 brothers-in-law, all of whom are close friends. I’d be the richest guy on the planet if we all lived in the same place. Even with all of them out of town now that my last in-town friend moved for a job, they are still all right there if I ever need them.

Where I think my Dad may have been less right was in the “staying power” of old friendships. Not like Starsky, for whom every friend ever met was worthy of his best everything, but guys who’d been friends at one time or another earlier in our lives. Some of these friendships are cooled by distance and years, quite reasonably so I think. Like the campfire that warmed you as you and your friends regaled each other into the night. And yet when an opportunity presents itself to breath life into the fire there remain tiny embers of flames that once upon a time had been burning brightly. These people, once friends, turn out to have been friends in waiting, there on the sidelines, ready.

One of these friends read between the lines of an email I sent into our epic, 180-strong email thread of men who went to college together. It doesn’t matter what I wrote, or what it was about, but my old friend Sonny sent me a note saying that he would be calling me the next day. Turns out he’s been experiencing a pretty similar life thing as am I. Not “are you free” or “ok if I call?”, but “I’ll be calling you” to take your pulse and tell you what worked for me. Along the way of offering his help and his time he pointed out just how not far away from each other we now live and how many new stories we must each have to share.

The “what” of our call, as you’ve likely guessed, wasn’t at all the thing. I have no idea where I was in Sonny’s circles, or frankly where he was in mine, but for all of the years and all of the miles between us and those nights around the fires of our youth, we were once friends enough that the tiniest opportunity to resurrect those buried embers was enough. I’m better off in every way for his call.

I’ guess what I’m saying, again, is that you can never have enough friends, especially if they are friends like Starsky and Sonny. We all miss Starsky. How fortunate am I that in addition to the best friends outside my family, I also have men like Sonny. He and I, once very good friends, remained friends in waiting, our circles close enough to be warmed by the same fire.

I’ll see you next week…