Sunday, August 31, 2008

End of Summer Call

So, here it is the last weekend of summer, and I am on-call. Normally, there would be a medical student on as well, but they finished their rotation on Friday. So I am alone. Luckily, there are only 11 patients in the ICU. I plan to write "on the fly" during the call, so let's start off with the major players. Check back periodically, for, hopefully, updates.

11:20 - 11 patients in the ICU: 3 MVC's (motor vehicle collisions), 4 post-ops, a fall down stairs now with a broken neck, the young patient who had the car fall on them, a stabbing, and the ATV rider with the head bleed. I plan to transfer 2 out of the ICU by the afternoon. The stabbing victim has lost the bottom part of their ear and is going to have a wicked scar down their left cheek along with some loss of sensation in that part of their face. One of the MVC's is lucky that they were wearing their seat belt and the airbag went off when they had their head-on collision. Things could have been much worse. Again, pot can kill. That's about it for now. We'll see what the rest of the day, and the great weather, will bring.

1940 - The day has gone well so far. Except I had one death in the post-op group. They had a lot of illnesses, and as I have said before, seniors just don't have the reserve to overcome a major insult. I was also able to send the stabbing victim up to the general ward. I've had one admission. They fell down some stairs two days ago. The family found them at the bottom of the stairs unconscious but because of the patient's known alcohol use, the family thought they just needed to "sleep it off." Yesterday, the patient was fine. Today, not so much. They were confused and agitated. Turns out they have bleeding into their brain. There's a plan for neurosurgery to operate on them tonight. So, I am minus two, plus one. Rumors and speculation are that we might be getting another one, but I haven't heard anything yet. The evening is just beginning, and there's plenty of havoc still to be wrought. Will keep you posted...

9/1 0140 - Well, a lot can happen in 6 hours; like the2 more admissions I just got. One fell off of a ladder while working on the ceiling. High ceiling because they fell about 12 feet. Numerous broken ribs, and I had to have them intubated (breathing tube put in) because we couldn't control the pain AND have them be able to take good breaths. The second fell out of a tree stand. Not quite hunting season yet, so we're unsure what they were doing up there, but regardless, they fell about 18 feet. One broken vertebrae, and they're acting "strangely" so they come to the Trauma ICU. Oh, and to add some fun to the rest of my night, reports are that there was a riot at Attica prison, and there were a number of stabbings; all coming to ECMC. One sounds serious enough to probably be going straight to the OR. The rest we haven't heard about yet. They haven't arrived yet, but I am trying to get a jump on my morning work... speaking of which, have to be going. The patient with the brain bleed just got back from surgery, and they need a central line. Will probably fill in the rest of the night later this morning when I am finally home... home... sigh.

12:27 - Finally, home. Almost 30 hours' later from when I left. The final body count: one death, one transfer to the floor. Minus two. Four admits leads to plus two balance on number of patients. My admits last night: got drunk and fell down stairs - massive head bleed requiring surgery to drain the blood, got drunk and tried to hang some ceiling tiles then fell off scapholding - broken clavicle and multiple rib fractures so not able to breathe well and had to have breathing tube placed, got drunk and high on home grown marijuana then got depressed so climbed up 18 foot hunting stand and subsequently fell but not found for 6 hours - broken top of vertebrae actually pretty lucky no other injuries, and finally got drunk and high then drove off embankment down 20 foot ravine rolling car over several times - broken ribs leading to laceration of a part of lung and spleen causing massive internal bleeding... too bad you were still too drunk when I admitted you this morning to realize the error of your ways. As for the prison rioters, well none were admitted to the ICU, and the worst of the lot had a cut ear, cuts on the face and a long cut on the forearm. They'll all live to fight another day.

As for me, I am going to sleep now so I can get back to patching up the next round of revelers in the morning...

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