It’s the first day as an anesthesia “upper level”. This consists of running the operating room traumas, responding to all code blue’s or emergency intubations in the hospital, discharge same day surgery patients home and managing the second year anesthesia residents and CRNAs. My shift is from 3pm-7am. Upon arrival at 3pm, I immediately get a phone call and page from the medical ICU. They have a patient that they are ready to extubate but want anesthesia at the bedside “just in case”. I go set up at the patient’s bedside. O yea, she speaks Swahili so we just did the head nod to communicate. Luckily, she was easy to extubate. The next four hours were spent discharging patients home from surgery and getting trauma patients ready for surgery. Then 2 paramedic students come to shadow me for the night to get intubations. Great, just something else to keep me busy. Just when I think I’m gonna put my feet up, I hear, “STAT Craniotomy to OR 11”. I page the residents and CRNAs to start setting up the OR, run down to the ER to see whats going on. Of course, gun shot wound to the head–drug deal gone wrong (this happens quite frequently). After convincing the police officers that I do have drugs but mine were legal, they let me into the ER bay where it looks like a scene from TV. Blood everywhere, people screaming. Like the typical anesthesiologist, I go straight to the airway, secure it, place and IV and transport the patient to the operating room. I’m not even gonna lie, the main thing on my mind was, “Please stop bleeding-I don’t have an extra pair of scrubs in the scrub machine!” As we get to the operating room, I stop and tell the police officers that they cannot come in the room but are free to wait outside the door. One of them taps his gun and says, “I’ll be right here in case he tries to escape.” Really?!? Anyways, with the help of my magnificent team of CRNAs and co-residents, the patient is adequately resuscitated. As I’m getting ready to transport the patient to the ICU, my attending sticks his head in the door, gives me a thumbs up and says, “You good?” My first time seeing him all night. Then of course the police are still standing there. Apparently they have to remain at the bedside because often the person who attempted murder will often try to ‘finish what they started’. The rest of the night remains steady, but no code blue’s or emergency intubations. I have lecture at 6:15am and afterwards, give checkout and leave. Survived my first call as chief. Pager off.