23.5 hours down; 30 minutes to go and then I can leave The House of Doom and go home! I should be trying to sleep now on the lumpy hospital cot, but the anticipation of leaving is killing me. In fact, nothing happened after midnight, but my sleep was fragmented anyway, as it always is when you're on call and dreading the fact that your pager may go off or the overhead intercom may scream "anesthesia stat!"

90 minutes after I wrote my post of bliss and quiet at The House of Doom yesterday morning, I found out that a gunshot victim was coming up. The senior resident and I ran to one of the designated trauma operating rooms, and only 30 seconds later the patient was already being wheeled in.

As I stood over his head, placing monitors on him, he was crying in anguish and screaming "I can't breathe!" I held a facemask containing oxygen over his face and, although I myself was screaming with anxiety inside, I said to him in the most soothing voice I could, "this is oxygen, concentrate on taking nice, deep breaths, in and out..."

As with other traumas, there was so much going on, so many people in the room, and extremely high anxiety and stress in the air. Induction and intubation almost at once, the surgery resident is placing a chest tube, I'm placing an arterial line, the senior resident is placing a central line, the surgeons are already prepping and draping, blood transfusions are running, and the patient's vital signs are out of control.

Someday I'd like to get so good that I could remain absolutely calm in a crisis such as this. I am already starting to see that the measures of progress in anesthesia training is gaining the ability to handle more and more pressure and difficulty in less time and less stress.

The case ended in four hours; the patient is made it alright to the ICU; the source of bleeding was found in the liver, and part of his liver was removed. Damage to the stomach and diaphragm were also repaired. "What is going on out there that this guy was shot in broad daylight? They don't wait for nighttime anymore?" some people said. I wasn't complaining. Better in the daytime when I was still awake rather than at night when I was in the middle of sleeping.

Still, taking care of him was an immense responsibility and I thought alot about why people did this to each other. I wondered who did this to him, and if it was part of the ongoing gang wars that's tearing our city apart. He was only in his 20's.

My senior resident was complaining later on. "I never knew about black culture until I got here," she said. "These people are ANIMALS. Wild animals. They get pregnant at 16, they kill each other, and they have these dumb looks of wildness on their faces." She complained on and on about the patient population here.

Honestly, I came here for this kind of patient population. In college, most of my volunteer work was with underprivileged inner city kids. In medical school, all of my rotations were at inner-city hospitals with underprivileged, underserved patients. I am handling cases of intense complexity everyday because these patients are poor, don't see doctors until they're well advanced into their diseases, and are challenging to take care of. Call me crazy, but I like it.

There's more I'd like to say but there are only 10 minutes left before the new team comes to relieve us.... gotta run!