When I was an intern, I learned more from my supervising residents than I learned from anyone else. Running together to resuscitate a dead person at 2 a.m., doing gastric lavage on a GI bleeder at 3 a.m., and treating a 4 a.m. overdose with charcoal and more gastric lavage tends to be a bonding experience. At rounds the next morning, our well-rested attending was usually gentle and wise, but it was my residents who taught me how to treat patients and who always protected me.

One resident said. "I’ll always have your back, even if you screw up. But you always have to come clean ‘cuz remember that you can lie to your friends. You can lie to your parents. You can lie to your wife, and you can even lie to yourself, but you can NEVER EVER lie to your resident."

I remember one case of severe urinary tract infection. Our attending that month wanted us to personally review the urine under a microscope, which, in this patient, I told my resident that I did not have time to do, choosing instead a half hour of sleep. When the well rested attending asked the next morning what the urine showed, I stammered; my resident confidently blurted out, "Sheets of white cells. Loaded with 'em. You shoulda seen it!" Then she quickly asked a difficult question about the physiology of type IV renal tubular acidosis, a subject on which our attending was an expert.

When I became a resident, my younger brother Paul became an intern, and for two hilarious months, we rotated on the same intern-resident team. He was the best intern I worked with.

Paul and I ran through all the usual emergencies, codes, and trials by fire. We used pagers back then, and I had told Paul at the beginning of the month, "add *911 to the call back number if it's an emergency, but only if it's really an emergency." 

Being on call together every fourth day, working 36 hours in a row, often without sleep, is something that changes your perspective and the meaning of things.

One night I was the ER while Paul was in the ICU where a patient developed chest pain and an ECG showing a new, severe heart attack. Paul paged me, but didn't put in *911. When I got around to calling him, he told me what was happening and asked what to do. I ran up to ICU, we sent the patient off to the cath lab, and ultimately the patient did well. At some point, I asked Paul, "Why didn't you use the *911?" Paul replied, "You said to use 911 only if it was an emergency." "But, Dude, a heart attack IS an emergency."

My brother reminded me of this story just the other day. As it happened, that same day, I saw a patient in the office who was telling me about worrisome symptoms he had felt one night in the prior week — symptoms of dizziness, chest pain, shortness of breath, jaw pain that felt just like his prior heart attack. He struck me as the kind of person who rarely complains, but he seemed shaken up by this event. When I asked him why, if he felt he might be having a heart attack, he didn't call 911. He said, "Well, I would only call 911 if it were a real emergency."