*ref: DJ Shadow "Why Hip-hop Sucks in '96"
(it's the money)
so i worked this whole weekend. so what.
today i showed up for dayfloat at the other hospital we have to work at, which requires me calling a cab to get to and from there on the weekends (because the shuttle which runs at very particular times onloy runs from mon-fri).
dayfloat during the week means you take sign-out from the interns as they finish up their work and leave for the day, and just answer pages for them until 5:30pm when night float shows up. it's actually pretty boring and easy for the majority of the day, and usually only gets a little busy towards the 5:30 mark (murphy's law).
dayfloat during the weekend is much worse. you have to write progress notes (daily progress notes are required on each and every patient - and the primary team gets one weekend day off per week, so the dayfloat writes notes on those days) as well as do any work required for the patients (whereas on a regular day, the primary intern would do all the work and tie up all the loose ends BEFORE signing out).
so i was already not looking forward to today before i woke up.
i showed up at 7:30am and was immediately warned by my first sign out (who was already waiting for me) that this one lady was breathing hard and rapidly, and her oxygen saturation wasn't as good as it should be. hmm.. okay. so i'll go see her first and foremost and make sure everything is okay.
this is a pretty sick lady. she came in over 2 weeks ago with an MI (myocardial infarction, aka heart attack) and was promptly sent to the cardiac cath lab, where they perforated her LAD (left anterior descending artery, a pretty fucking important coronary artery). she ended up in cardiac tamponade (blood filling the inelastic pericardial sac which surrounds the heart, compressing it and preventing it from contracting fully or effectively) and began throwing emboli (lil' blood clots) everywhere. she developed strokes on both hemispheres of her brain, bowel ischemia (essentially, clotting off the blood supply to the intestines and effectively killing it) and GI bleeding, and cyanosis of her feet (again, due to clotted off blood supply). however, she remained mentally stable in spite of all of this, and was able to talk and understand her situation, although at times she would become confused. normally in a patient like this we would use heparin to anticoagulate the blood and prevent it from clotting (and in turn, making it more likely to bleed), but they couldn't, given the fact that she had GI bleeding.
so i went down to see her (never seen her before - only covering) this morning and she looked bad. unresponsive, unarousable, eyes lolling back and forth (nystagmus), pupils hardly reactive to light, not moving any of her limbs, not reacting at all to pain. within 15 minutes respiratory therapy had intubated her. over the course of the next few hours i called critical care medicine, pulmonary, vascular surgery (her toes were looking worse and now her hands were turning purple), neurology, cardiology (she was having another heart attack), and hematology.
everyone said the same thing: prognosis poor, no [surgical/neurologic/cardiac/critical care] intervention indicated at this time, thank you for consult, please call us with any issues. so i basically called them all back several times today.
by the time i signed out at 5:30pm we were still waiting for hematology to call back and critical care were refusing to take her to the ICU because there was "nothing we can do" (although they expected the nurse on the floor to check vitals every 15 minutes - ridiculous!).
so that was one patient.
i covered about 30 or 40 patients today. there's two dayfloat people. technically the full patient load of coverage is divided more or less equally between the two. but there's no telling how sick one group is versus the other, so the work load can end up being very disproportionate despite the best of intentions.
but the schedule had been messed up today. unfortunately we didn't figure this out til the end of the day when the other dayfloat and i were both signing out. turns out all the interns who were sticking around all day because they were on call were assigned to the other dayfloat. that means that they're in the hospital, hence no sign-out. all the interns that were leaving early or had the day off were assigned to me, meaning i received nearly ALL of the sign-outs.
the tally at the end of the day was that i carried the boards for 8 interns and she carried 2.
..
oh, and i forgot about daylight savings and woke up and got ready for work an hour earlier than i needed to.
..
tomorrow i'm dayfloat at the nearby hospital. tuesday i begin overnight shifts in the ER, four in a row.
..
huh. and i was wondering why i was depressed.
this educational lesson brought to you by dr. j around 7:28 PM |
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"MASTER OF PUPPETS I'M PULLING THE STRINGS........."
dropped by 
on 30 October, 2006 10:54 [*]
~$$$~
That woman should've been intubated before you even woke up that day. Sounds like you took sign out from a shitty intern.
Look on the bright side, it can basically only get better from here. Soon enough you'll be doing anesthesia & laughing at how fortunate you are to NEVER EVER do floor medicine again.
EVER.
dropped by on 09 November, 2006 17:36 [*]
~$$$~
drop some science: