It’s My …

Last Day.

…of the ICU

…of inpatient medicine

…of rotations with overnight calls

…of sitting through 3 hours of trauma/critical care rounds, falling asleep in the dark

…of chasing interns orders

In celebration

my post from last year’s last day in the ICU and my last day as an intern…

The Rest of the Story

Last night’s lessons in the ICU all involved interpersonal interactions…much like previous call night’s lessons. These however, all involved conflict with other hospital staff & physicians…

For starters. I take a trauma patient to MRI with known spinal fractures and in spinal shock, on levaphed & fluids. People start moving and pushing him around until I yelled, “STOP!” People get so used to seeing patients in C-collars with “Log Roll Only” instructions that don’t have real injuries that they forget how to treat the patients that DO have real injuries. If you’re curious, the person at the head should always count…nobody moves the patient until the person at the head gives the command!

OK, Next. The MRI tech is pissed that I use up MRI time waiting for pressure tubing to materialize so that I can monitor my patients continuous arterial blood pressure…you remember, the patient in spinal shock on vasopressors and fluids? I asked her what people usually do in my situation. “They just stop them [drugs] for the MRI.” Let’s see…I didn’t go to four years of evil medical school to have this lady tell me how to take care of a spinal shock patient, even if I am using up valuable MRI time taking care of him properly. As it turns out, after waiting for about 15 minutes for our runner to go to the ICU, get tubing without the right connectors and come back down, suddenly the right tubing materializes in the MRI suite. Hadn’t we just asked them if they had some?

Don’t even get me started about this patients spine surgeon who told the nurse the neck was cleared but didn’t leave a note documenting his visit in the chart. I refused to let the nurse take his cervical collar off without first hand evidence and confirmation of the information she had been given. I called the ortho/spine resident on call who basically blew me off. It was a good thing too, because this morning, on reviewing the MRI, his neck was not OK. Always check labs and imaging studies yourself.

Hmm…so now we’re about to yesterday afternoon at 3pm. I did mention that I was on call overnight, right? So the rest of the afternoon and night went like this until this morning, when the 3 upper levels had to present the whole service to the new interns as well as the attendings. That went over like a ton of bricks for everyone.

Oh so many more morbidly frustrating things I could write about, but you’d probably just get bored with this post and quit reading altogether.

Time for sleep, time for crawling into my post-call world of darkness.

Last Night

With 15 months and 2 days to serve in my residency, I am doing my last call night ever tonight! It’s about 3:30AM, and I’m just starting to see patients for just one day of role reversal. The new interns start tomorrow, so my intern is off to bed so he can start cardiology in the morning (in 2 hours, that is). So I have only a few more hours to go before I am done with call FOREVER! The remainder of my time will be in the Emergency Department, or doing electives or research. 😉

No call night would be complete, however, without someone becoming an organ donor. True to form, a young man on the east side of the unit was declared dead at 8:30pm. And, true to form, the attending didn’t tell me until I was about to go to bed at 1AM, leaving me with death certificates, notifications, dictations and organ donation forms to fill out before getting few hours of shut-eye.

In those hours between his death and his death certificate, we put in four lines. Well, collectively we put in four lines. I cannulated an artery on one patient, after following the attending’s explicit instructions on where to try to find the vein (I knew he was wrong, because he wasn’t touching the patient and I was).

Anyway, it was as crappy day as can be expected. More later.

Bedside vigil

Bedside vigil

The family of the Amish man is singing again as I sit here and type. I moved down to the closest nursing station to listen. There is one man and two or three women, dressed in simple black clothing. The language isn’t English, it’s probably a version of Pennsylvania Dutch or German. They’re singing now is in a minor key now. The rest of the unit is silent, I’m sure that anyone who is awake now can hear them.

They’ve been singing now for 10-15 minutes and at first were timid, but now they sound uninhibited by the fact that they are in the ICU. I would like them to keep singing all night. My book is open in front of me, but I’m only pretending to read. I wish the cleaning people would move on to the other side of the unit, and that the nurses behind me giving the 8 o’clock meds would just sit down and relax for awhile…maybe give them an hour late tonight?

They’ve finished, each said their goodbyes and left the unit, crying silently with one another. I think they are going to withdraw his life support tomorrow. I think he’ll be in a happier place then. Not stuck here in the ICU…he can be with them no matter where they are singing.