I knew it wouldn't be a "quiet" night. There's a reason for superstitions, they come true sometimes. I thought about this at 3:30 in the morning when we finally got our 3 new patients tucked in for the night after: placing a central line in one because they were hypotensive requiring pressors and fluid support, intubating another because despite COPD and probable lung CA they continued to smoke ("but I'm down to 10 a day from a pack a day for the last 30 years"), almost needing to intubate a third patient who suddenly started having problems breathing, and admitting the third patient who decided to wait 2 days before coming in with a pretty significant heart attack. Oh, yeah, another ethics dilemma: should we be giving organs to people who don't follow up with their physicians, return to doing drugs, albeit not IV drugs ("a little marijuana now and then won't hurt"), and who don't take care of themselves in general?
Anyway, once the commotion seemed to settle down, I turned to my senior and told him it was his fault for using the "Q" word yesterday. Suddenly, all four ICU nurses turned to him and said, "You used the "Q" word?!?!?!" He looked around at them and said, "How come everyone knows about this except for me?" I might have stated the obvious which is that he's a foreign medical grad who after 3 years of training in the US has not absorbed some of the nuances of our language, but I didn't. I went off to my happy corner of the hospital to catch 2 hours' nap on a comfy recliner before having to come back to the unit to pre-round on my patients.
A nice longer nap when I got home, some pajama time with the kitties, and I am now preparing for a short round session (hopefully) in the morning followed by my 24 hours off on Monday. Too much to do...!!
CCU Countdown:
Days left until the end of the rotation: 15
Actual number of days I will be working during that time: 13
Days left until painful attending returns: 8
Number of days until my next 24 hours off: 1
Number of short call shifts remaining: 2
Number of long call shifts remaining: 1
Number of patients: 3
Number
of evil Internal Medicine residents: 3
Number
of evil CCU nurses*: 3 (*names have been changed to protect the innocent, mainly me... :D)
Saturday, December 22, 2007
Friday, December 21, 2007
Very Superstitious
I am on-call in the hospital overnight. I think both ED and surgery residents are a very superstitious lot. And, there are two words you never want to hear when you are on-call. The Q (opposite of noisy) word and the S (opposite of fast) word. Because as soon as you say, "It's kinda ____ " it won't be.
I have actually threatened my resident with torture since he used the Q word earlier this afternoon. So far there's only been one admission, but the night is still VERY young, and I know there's at least one more admission coming.
I used to threaten the ICU nurses with payback if they ever used either word. Of course, it did no use since they could hurt me tons more than I could ever hurt them. But, still, it really did seem to be more busy or chaotic when those words were uttered.
So, let's just wait and see where the evening takes us, shall we...?
CCU Countdown:Days left until the end of the rotation: 16Actual number of days I will be working during that time: 14Days left until painful attending returns: 9
Number of days until my next 24 hours off: 2
Number of short call shifts remaining: 2
Number of long call shiftsremaining: 1
Number of patients: 1 +1 pending
Number of evil Internal Medicine residents: 3
Number of evil CCU nurses*: 3
(*names have been changed to protect the innocent, mainly me... :D)Number of days until my next 24 hours off: 2
Number of short call shifts remaining: 2
Number of long call shiftsremaining: 1
Number of patients: 1 +1 pending
Number of evil Internal Medicine residents: 3
Number of evil CCU nurses*: 3
Thursday, December 20, 2007
Breaking in the Boots
A day off and one of my work colleagues and I went to the slopes. There's a local ski resort - Holiday Valley - which wasn't too far a drive. I had a new set of snowboard boots, and I was glad to break them in and not have anything broken on me by the end of the day.
I have to admit, I've been snowboarding for about 10 years now, and I haven't really progressed above advanced beginner. Unfortunately, every year I feel a bit older than the rest of the boarders, and it really shows in my carefulness making my way down the hill. It also doesn't help that I when I first started we only would go for a week about once a year, and the following year you'd pretty much have to start over.
Last year, though, I was able to make it about 5 or six times during the season, and I definitely was better able to kind of "pick up and go" when we got to the resort today. Now if I can keep my feet from cramping I should do ok. I know for sure, I want to go back again soon. There weren't a lot of people, and there's something to be said for being on top of a large hill enjoying the silence.
Ah, silence. I'll slip back to this happy place I am sure tomorrow when I am on-call overnight again. And, I am sure my muscles will give me a constant reminder throughout the day, as if I needed any...
I have to admit, I've been snowboarding for about 10 years now, and I haven't really progressed above advanced beginner. Unfortunately, every year I feel a bit older than the rest of the boarders, and it really shows in my carefulness making my way down the hill. It also doesn't help that I when I first started we only would go for a week about once a year, and the following year you'd pretty much have to start over.
Last year, though, I was able to make it about 5 or six times during the season, and I definitely was better able to kind of "pick up and go" when we got to the resort today. Now if I can keep my feet from cramping I should do ok. I know for sure, I want to go back again soon. There weren't a lot of people, and there's something to be said for being on top of a large hill enjoying the silence.
Ah, silence. I'll slip back to this happy place I am sure tomorrow when I am on-call overnight again. And, I am sure my muscles will give me a constant reminder throughout the day, as if I needed any...
CCU Countdown:Days left until the end of the rotation: 17Actual number of days I will be working during that time: 15Days left until painful attending returns: 10
Number of days until my next 24 hours off: 3
Number of short call shifts remaining: 2
Number of long call shifts remaining: 2
Number of patients: 0!
Number of evil Internal Medicine residents: 3 - I am throwing the cardiology fellow in there because he makes us go look at angios and echos every day, and I had my fill of squiggly lines last month on ultrasound
Number of evil CCU nurses*: 3
(*names have been changed to protect the innocent, mainly me... :D)Number of days until my next 24 hours off: 3
Number of short call shifts remaining: 2
Number of long call shifts remaining: 2
Number of patients: 0!
Number of evil Internal Medicine residents: 3 - I am throwing the cardiology fellow in there because he makes us go look at angios and echos every day, and I had my fill of squiggly lines last month on ultrasound
Number of evil CCU nurses*: 3
Wednesday, December 19, 2007
Wiping the Slate Clean
I have no more patients. The "I don't do drugs, but my tox screen came back positive" patient went to the private service, and my unstable angina guy is FINALLY getting his surgery. So, going into my 24 hour day off, I am free of patients... of course, I am on long call Friday, so I am sure to pick up an admission or two.
Today was another "Grand Rounds" Wednesday, so I showed up in the morning to round on my patients, left for my meetings, came back around 2 p.m., stayed until about 4:30 and then called it a day. We like Wednesdays.
There's really nothing else going on... kinda boring by most standards. I am actually sitting at the computer wearing my new snowboard boots and trying to get them sort of broken in. The plan is to expend all my extra energy on the trails tomorrow. Considering I haven't been on a board in about 9 months, my first day out should be pretty entertaining. I plan to take my camera, so I will probably post pictures tomorrow.
Until then, then countdown continues:
Today was another "Grand Rounds" Wednesday, so I showed up in the morning to round on my patients, left for my meetings, came back around 2 p.m., stayed until about 4:30 and then called it a day. We like Wednesdays.
There's really nothing else going on... kinda boring by most standards. I am actually sitting at the computer wearing my new snowboard boots and trying to get them sort of broken in. The plan is to expend all my extra energy on the trails tomorrow. Considering I haven't been on a board in about 9 months, my first day out should be pretty entertaining. I plan to take my camera, so I will probably post pictures tomorrow.
Until then, then countdown continues:
CCU Countdown:Days left until the end of the rotation: 18Actual number of days I will be working during that time: 15Days left until painful attending returns: 11
Number of days until my next 24 hours off: 0
Number of short call shifts remaining: 2
Number of long call shifts remaining: 2
Number of patients: 0!
Number of evil Internal Medicine residents: 3 - I am throwing the cardiology fellow in there because he makes us go look at angios and echos every day, and I had my fill of squiggly lines last month on ultrasound
Number of evil CCU nurses*: 3
(*names have been changed to protect the innocent, mainly me... :D)Number of days until my next 24 hours off: 0
Number of short call shifts remaining: 2
Number of long call shifts remaining: 2
Number of patients: 0!
Number of evil Internal Medicine residents: 3 - I am throwing the cardiology fellow in there because he makes us go look at angios and echos every day, and I had my fill of squiggly lines last month on ultrasound
Number of evil CCU nurses*: 3
Tuesday, December 18, 2007
And She Was....
Couldn't think of a name for my blog today, so I decided to name it for the next song to play on my MP3 player. Kind of fitting actually since I was called "intimidating" by one of our medicine residents today. Ok, so I maintain a certain confidence and attitude. Mainly I think it's because of my prior training.
If I was a character on "Grey's Anatomy," I would definitely be a Bailey. Hard, firm, organized and a leader, but with a soft inner side that no one ever sees. I'm a "shortest distance between two points is a straight line" kinda person, and I guess sometimes when it comes to patient care, I don't take a "wait and see" attitude.
Which is so frustrating when it comes to being on a medicine service. No patient I ever treat in the E.D. will ever suffer because I didn't want to SUFFER through another round of "let's go look at everyone's cardiac angiography and discuss in minutiae the 10 differential diagnoses while I the fellow make all of you inferior beings look more inferior by asking you questions about angiography that I've been doing for six months while you've been on service for a week." In that respect, I am more like Christina... I need to cut open someone or stick a really big needle into someone's blood vessel just to make the day worthwhile. However, I don't get to do that. Hence, my frustration. Hence, my attitude. Hence, the countdown continues...
CCU Countdown:Days left until the end of the rotation: 19Actual number of days I will be working during that time: 16Days left until painful attending returns: 12
Number of days until my next 24 hours off: 1
Number of short call shifts remaining: 2
Number of long call shifts remaining: 2
Number of patients: 2 - 2 in the unit
Number of evil Internal Medicine residents: 2
Number of evil CCU nurses*: 3
(*names have been changed to protect the innocent, mainly me... :D)Number of days until my next 24 hours off: 1
Number of short call shifts remaining: 2
Number of long call shifts remaining: 2
Number of patients: 2 - 2 in the unit
Number of evil Internal Medicine residents: 2
Number of evil CCU nurses*: 3
Monday, December 17, 2007
This is Your Heart, This is Your Heart on Drugs...
I think during my ED rotations, I talked about patients coming in with chest pain from doing cocaine. Cocaine aside from making your heart race also closes down the coronary vasculature. So, it's like asking your heart to run a marathon and then cutting off the blood supply that keeps it going. Bad, bad, bad.
Keep doing cocaine over many years and you can imagine how much damage you can do. Now, just to add some fun to the mix have a family history (bad genes) of heart attacks, become a diabetic, have high blood pressure... oh, yeah, and don't take any of your medication because you "don't have any available cash." And, since you don't have any cash, wait about 6 hours for one of your "friends" from the half-way house to give you a ride to the hospital. Why use an ambulance? Your friend can get you there just as fast.
Keep doing cocaine over many years and you can imagine how much damage you can do. Now, just to add some fun to the mix have a family history (bad genes) of heart attacks, become a diabetic, have high blood pressure... oh, yeah, and don't take any of your medication because you "don't have any available cash." And, since you don't have any cash, wait about 6 hours for one of your "friends" from the half-way house to give you a ride to the hospital. Why use an ambulance? Your friend can get you there just as fast.
Of course, when I come to see you in the E.D. to admit you, you've sworn up and down you don't use drugs. Or drink alcohol. Or smoke more than a cigarette or two a day. I think I might believe you more if you wore long sleeves and didn't let me see the fresh track marks on your arm. But, that's just me. I always want to believe my patients... but, then I think of "WWHD?" (what would House do?) and I remember the mantra "everybody lies."
So, until your urine and blood tox comes back negative, I will have to withhold one of the drugs proven by research to be the best for people having heart attacks because since you do cocaine, the interaction between the two just might kill you. Not that the major coronary you're givingyourself isn't going to do that for you. Of course, given the choice between spending my money on street drugs versus pharmaceutical drugs, I might also choose the funner one.
That was my one admission for the night... the countdown continues...
CCU Countdown:Days left until the end of the rotation: 20Actual number of days I will be working during that time: 17Days left until painful attending returns: 13
Number of days until my next 24 hours off: 2
Number of short call shifts remaining: 2
Number of long call shifts remaining: 2
Number of patients: 2 - 2 in the unit, my floor patient went home
Number of evil Internal Medicine residents: 2
Number of evil CCU nurses*: 3 - Rude Ruby (who acts as though interns are small slugs she has to avoid at all costs, and she also never shares the vitals' book because she might need it 20 minutes from now after she's given report about one of her other patients in the unit), Weird Wendy (who turned off the radio because all the "thumping" was making her head pound, and who spazzes out about the littlest things), and Miss Biche (who complains all day long about everything, especially how interns have no training in doing simple things like writing orders, and who doesn't bother to learn anyone's name since it doesn't really matter to her anyway)
Number of days until my next 24 hours off: 2
Number of short call shifts remaining: 2
Number of long call shifts remaining: 2
Number of patients: 2 - 2 in the unit, my floor patient went home
Number of evil Internal Medicine residents: 2
Number of evil CCU nurses*: 3 - Rude Ruby (who acts as though interns are small slugs she has to avoid at all costs, and she also never shares the vitals' book because she might need it 20 minutes from now after she's given report about one of her other patients in the unit), Weird Wendy (who turned off the radio because all the "thumping" was making her head pound, and who spazzes out about the littlest things), and Miss Biche (who complains all day long about everything, especially how interns have no training in doing simple things like writing orders, and who doesn't bother to learn anyone's name since it doesn't really matter to her anyway)
(*names have been changed to protect the innocent, mainly me... :D)
Sunday, December 16, 2007
The Great White Way
I woke up this morning to a blanket of snow. I had to go into the hospital to round and was running late due to a faulty alarm clock, so it didn't help that people were slipping and sliding all over the freeway. I got to work (Lord, bless one of my colleagues who got numbers for me and the fact we don't have an evil attending over the weekend) just in time to get into the hospital garage before it really started coming down.
After about two hours in the hospital, I got to drive back in about an inch or so that had already fallen. Yeah for my Jeep with 4 wheel drive! I pretty much came straight home and tucked myself and my Jeep in for the day.
The kitties and I played pajama party. We ate and slept and played all day. Back to the evilness in the morning that is the CCU, however I've heard good things about this week's attending so we'll see. The countdown continues.
CCU Countdown:Days left until the end of the rotation: 21Actual number of days I will be working during that time: 18Days left until painful attending returns: 14
Number of days until my next 24 hours off: 3
Number of short call shifts remaining: 3
Number of long call shifts remaining: 2
Number of short call shifts remaining: 3
Number of long call shifts remaining: 2
Number of patients: 2 - 1 in the unit, 1 on the floor, 2 went to private service
Number of evil Internal Medicine residents: 2 - the one who made me stay up all night and the one who accused me of not calling an attending because she happened to speak to him 5 minutes before I did.
Number
of evil nurses in the ICU: 2
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