We capped with 10 team admissions a little after midnight–so it was a busy admission afternoon/evening and not so much a busy early morning for admissions. I admitted three patients and a fourth went straight to the ICU which counted towards our cap meaning little to no work on our part. The other intern admitted four patients and our fourth year “acting intern” admitted two. The upper level resident supervises all the admissions so we can say he admitted 10.
There were three code pages throughout the day, but two were canceled quickly because the MICU doesn’t like to announce codes–they deal with them internally. The final code came at about 4:30 AM–from Radiology. Oops. When I got there it was merely a respiratory code. The patient was tubed and shipped back up to the floor.
But the main problem with call is the “cross cover”. I fielded phone calls all day and night on patient’s I’d never met. I ordered some Phenergan. I gave a patient a bit of morphine. I sent off a couple of blood cultures. I even wrote a work excuse for a patient’s husband.
In all I worked 29 hours and slept a mere 2 of those.
Welcome to residency.
I managed to find myself as the first physician present in a code situation today.
Talk about terrifying.
The nurses were performing chest compressions and giving bagged breaths for a patient this morning by the time I walked into the room.
I simply stood at the foot of the bed with a deer in headlights look and asked, “What’s going on?”
After an initial smart-assed response of, “Well, he’s not breathing”, I managed to get a bit of an event progression from the nurse who was already drawing up some epinephrine into a syringe.
Lucky for me…and the patient…a few more white coats with more experience arrived just as the nurse was finishing the history. I was off the hook for “leading” the code–and the patient was better off for it.
Of course, I broke the number one rule of code situations…
I forgot to take my own pulse.
What a morning.
*Editorial Note: On Friday I carried the code pager for the day, and it did go off. I was half way across the hospital and by the time I got there the code was finished. Apparently the patient was a DNR–or some such. As such I don’t count that as the first code of my career.
I admitted my first patient today.
Last month I worked on a consult service–so I never had any of my “own” patients.
That all changed today when I admitted a patient with pulmonary hypertension.
It was mostly grunt work–filling out orders, doing a rectal, etc. Ya know, the normal intern stuff. We got the patient a bed and I then promptly “checked out” to the intern on call for the evening. I felt a bit guilty dumping a sick patient on the overnight intern–but that’s what the 80 hour week does for us.
It’ll be my turn on Sunday when I have my first call day/night.
Should be a blast.
I like to think I do a reasonable job and reducing medical explanations into something just about any patient can digest. Saying things like “bugs” for bacteria or “your body fights back” for immunological response help tone down the high brow medical discussion. Simple stuff. No big deal.
But I’m often amused by the way patients comprehend the disease process.
For example, I was recently seeing a young, homeless, female patient who was dealing with a simple pneumonia–nothing spectacular. But during a routine screen of her liver function via a complete metabolic panel–a series of lab tests that evaluate liver function, blood constituents, and electrolyte levels–we noticed that she had poor liver function.
I decided to interrogate the patient as to the potential causes of the bump in liver enzymes. While she couldn’t put her finger on any one process that may have caused the problem–she wasn’t drinking anymore and she rarely used Tylenol–she did mention that a bunch of years ago someone told her she had a “touch of hepatitis”.
I’m still trying to figure out exactly what a “touch” of hepatitis is.
Must be a similar condition to “a little pregnant”…
