By Jeff Balke
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"He was so excited, it made me excited for him," remembers Trip. "I went around with some different doctors in Knoxville for a while and thought, 'If I could do anything, that's what I would do.' And I also, having met some people in sales, was unimpressed with my new group of peers."
Trip finished premed studies for admission to Tulane Medical School while working in a hospital that had no trauma center. A particular incident fed his growing fascination with surgery.
"I was an orderly, picking up urine and getting whatever the patients needed and stuff. There was a car wreck right out in front of the hospital, and they brought the person right into the hospital 'E' room, and she was in really bad shape."
A surgeon came out of an operation upstairs and took over. "He's says, 'Everybody shut up. I want you and you out of the room.' " Trip ran to get blood and returned to watch the impromptu operation.
"This guy is cutting into her chest -- she's dying right there," he recalls. "The surgeon stabilized her and took her up to the operating room. I was in shock. I was so impressed, I said to myself, 'I want to be like that guy.' "
Trip's five-year Baylor surgery residency schedule mandates a cycle of on-duty and on-call shifts that has him and his surgical team awake for stretches of up to 40 hours. Considering that federal law limits professional truck drivers to 12-hour shifts, the residency pace seems potentially unhealthy -- both for physician trainees and their patients.
Trip shrugs it off. "You get used to it. Some people can't hack it, and that's why not very many people go into surgery. It's a small specialty; we don't have that much room for people anyway."
For Trip and crew, 100-hour weeks are standard. Annual pay is around $36,000, working out to an hourly rate of $5.25. Professional prestige and high income are still years into the future.
We met on a Friday -- Trip's one day of the week to himself. Even that luxury is a recent improvement in residency work conditions, a decision by Baylor to humanize the grind.
"Surgery is fun to us," says Trip. "Otherwise it wouldn't be worth working the kind of hours that we do. You're really privileged to do the things that we do -- and it's a lot of fun. Exciting to see all the trauma, exciting to operate on people and then follow them as they get better. The whole thing is pretty nice."
In the third year of residency, Trip works shifts at Methodist, the Veterans Administration and Ben Taub. The latter is the most difficult.
"Most of the people we get there are, you know, drunk when they come in and not very appreciative when they leave. You have to be really self-satisfied with your work in particular, and not gaining appreciation from patients."
He cites an example from a recent shift: "It's a very rough-and-tumble environment, when you are trying to take care of somebody and they jump up and start pissing on the floor. We found $2,500 on him and some crack cocaine."
I tell Trip that had I gotten out of the hospital two hours after he sewed me up, my impression of the facility would be totally different. An impatient nod indicates it's a complaint he's heard many times before.
"As soon as you are downgraded from life-threatening to merely an emergency room patient, you really feel the Harris County Hospital District system," says Trip. "The problem is we have too few people, who are paid too little, that work too hard."
"People routinely stay there in the emergency room close to 24 hours," he explains. "It's absurd. But in the believe-it-or-not category, it's easier, even if a patient is going to get admitted to the hospital, to get something done in the emergency room than it is on the floor. Once they go up to the floor, it's really difficult to get scans done."
The problem is that once a patient is stabilized, incoming emergencies have priority. On a busy night, that relegates everyone else to limbo.
The prescription, in this doctor's view, is simply more money to hire the backup staff to prevent gridlock in the treatment chain.
Shortages range from the critical-care nursing staff to radiology technicians, "where the bottlenecks are," says Trip. "When you hear on TV that Ben Taub is on 'drive-by' because of saturation, it's usually not because we lack the beds but because we lack the staff to take care of patients appropriately."
"Every night can turn into mayhem," he says. "People wait for X-rays, scans, usually radiology -- as you found out -- for umpteen hours. That's just the way it is, and there's nothing any of us can do about it. You have nights where people decide just not to come in -- radiology doesn't come in -- and you're just killed."
He's referring to the doctors, of course, not the patients.
A few days after that reunion, I returned to the Ben Taub ER on a Tuesday evening, about the same time as my previous visit. This time around the trauma gods must have been in a good mood, or out getting drunk themselves. The center, Trip noted, was about as calm as it ever gets.