An excerpt from Twenty-Six.

5 a.m.

“Reminder to everyone, morning round at 6, lots of new patients,” flashes a message from Puta on the residents’ WhatsApp group.

It’s dawn, and the first rays of sunlight illuminate the corner of the bedroom. I roll over, but the alarm clock on my phone keeps ringing. I glance at Gadi in a deep sleep next to me, turn off the alarm and get out of bed. Another long day ahead of me, I think to myself as I get dressed, the reflection of my green uniform visible in the large mirror opposite me.

Over the past two years, it has become a regular ritual to set my alarm for 5 a.m., a ridiculous hour to get up, let alone remain sane until the end of my workday at 9 p.m., or worse still, until the following morning on a 26-hour on-call shift such as today.

I don’t remember a morning when I saw my girls awake. They are always asleep at this hour; disheveled hair, their bodies warm and sweet-smelling, Nitzan with the pillow over her head, as always, from when she was a baby, and Tamar with the door closed in complete darkness. I go to the living room, turn on the computer and inspect the list of new patients admitted to the ward. I brace myself for another day of war. On-call shifts like today provoke a sense of fear, a nervous stomach and agitation that never abate. Despite the experience and confidence I’ve gained since the start of my residency, the fear of the unknown constantly hovers over me and sometimes I feel it’s all too much.

A week ago, when I inserted a chest tube, all by myself, into a young man who had been injured in a car accident, I felt alone for the first time, wondering what would happen if I were to accidentally penetrate his heart or make some other error… dear God! There would be no one to hold my hand, which at times is what I need most.

I park in the hospital parking lot. It’s 5:45 a.m. and as the sun climbs above the cardiology building, I feel it’s welcome warmth. Luckily, it’s still summer and warm, because I am at my worst when I am both cold and tired. When I was young, I and my friend Inbal, whom I have known since the age of three, once tried to establish what the worst combination of unpleasant feelings is at any given time. We came to the conclusion that being hungry, having a headache, feeling cold and needing to pee, had to be the worst. But back then, I didn’t yet know what it was like to work in the ER as the attending surgeon with forty patients waiting to devour me like a pack of wolves, or to stand cowering in a corner of the OR while a senior surgeon barks at me.

I hurry to the ward round. The night shift nurses are filling out the end-of-shift report and preparing for handover. We residents, the “blue side” or “Puta’s side” as we call it, prepare for our morning round. Puta is like my big brother here. Even though he began his residency only a year ago, hierarchy on the surgical ward is similar to that of the military, or in Puta’s words (he served in an elite unit in the army where he became boorish and brought some of his crassness to the ward): “It’s enough for someone to be in residency a day longer than you for them to be considered your senior.” And this is how it is with Puta, Imrish and myself; Puta is the senior resident, Imrish the less senior resident, and I, the newest resident, who does all the dirty work and keeps out of everyone’s way.

Puta is a master of patient management. Some call him “the magician” because he knows exactly when a surgical patient ceases to be a surgical patient and becomes an internal medicine patient.

“Did you see that Mrs. Berkowitz passed a stool, Dreznik?” Puta quips. “It means she has no bowel obstruction. It’s time to introduce her to the internal ward because she has pneumonia.”

Imrish, who began his residency six months after Puta, is a real charmer, aided by his long forelock, contemplative look and great sense of humor. It was into this ‘gutter’ that I was thrown, and every day the three of us try to survive the morning round and finish it by 8 a.m. so we can get to the OR.

“Are you doing a lumpectomy with Dr. Kleiman today, Dreznik?” Imrish asks me, after we finish going over the ‘iron’—the tattered binder that lists the day’s tasks, such as blood tests, scheduled colonoscopies, angiographies and CTs for the patients on the ward. Dr. Kleiman is one of the veteran doctors in the department; an excellent yet very intimidating surgeon in the OR. Imrish always turns pale when he recalls how two weeks earlier he had failed to wake up in time for surgery with Kleiman, which meant only one thing: He had violated Kleiman’s law of punctuality; a sin for which the only atonement is death.

Luckily for Imrish, Puta was willing to cover for him and prepare for surgery in the OR, so that when Imrish arrived—breathless, goggle-eyed, a pillow crease still on his face—he could take over. Just listening to this story, which in the last two weeks has been told over and over on various resident forums, including Puta’s accurate and nonchalant account of how quickly Imrish scrubbed in, was enough to stress me out for today’s surgery, and I hope it will end quickly. As residents, we are eager to get to surgery, but there are times when I would rather sit in the ward than suffer in the OR, and today is one of those times.

Yael Dreznik is a pediatric surgeon and author of Twenty-Six.