Moments I will cherish from the Peterborough ER (in 2013) -
1. Man with epistaxis (massive nosebleed) requires packing to stop the flow. "Which side did it start on?" "The left." I then proceed to meticulously and painfully pack his right nostril. After some time he clears his throat and asked, "Are you going to do the other one now?" Oops. And yes.
2. Older man brought in by paramedics. Found in bathroom with no pulse, no vital signs. They had done CPR for an hour before he arrived with us. He was, in short, very unofficially dead. I, being team leader, have to run the code. I intubate him and then immediately declare him officially dead. My staff asks me "why tube?" Answer: Um...cos he was there??
3. Stab wound to L chest causing pneumothorax. Inserting chest tube, hearing that beautiful rush of air and hearing the patient say, "Oh...that's better".
Moments I will not cherish from Peterborough the town (in 2013) -
1. Discovering that when they say, "Let your car warm up before you drive it", they mean it. Did you know your brake pedal can freeze in place?
2. Trying to find one of 30 recommended breakfast joints in P'bo's famous "cafe district". They all close between Christmas and New Years. The only open cafe stopped serving breakfast "Oh...just....now." (watching the clock tick over to 11am). They deigned to serve me their leftover oatmeal. Plain. No milk. No sugar. Tepid.
3. Coming home starving from said breakfast debacle and desperately looking for food in the apartment. Other residents have lefts bits and pieces behind. Finding a tin of "fish-bites" - herring fillets in hot sauce. Eating said herring fillets. Spilling the hot sauce on my pants and the floor. Coming home to an apartment that smells entirely of herring.
Roses and thorns, really.
I'm working NYE until 1am. Am planning to scout out a party hat and some snacks for the shift.
Would really like to come home and chug champagne, but fear that that will somehow lead to further herring-related incidents.
Worse. Could eat the pop-tarts. They expired Jan 2013, but how bad could they be?
Monday, December 30, 2013
Wednesday, December 11, 2013
Maturity
What makes a "bad" call shift?
When I was a first year resident, I would lie awake in my narrow bunk, praying that nobody would page me. Any night that I didn't make a decision was a good one.
Last night, I got called twice between midnight and 7am. This is unprecedented, especially for ICU call. The calls I got involved simple medication changes (labetolol, I love you) and clarification of nursing orders. I never got out of bed. At one point I thought, "This is weird. Maybe I should get up and check if everything's ok". But then I reassured myself that my phone and pager were both on and working, and pulled the covers tighter.
As it turns out, I was right to be suspicious. The junior resident HAD received a call, a consultation from ER. He had seen the patient, made some decisions about treatment and done admission orders. All of this would be fine, but he had done it without making a diagnosis. He approached the patient with a shotgun of drugs, all for different causes of respiratory failure, and gave them all.
I went over his decision making with him this morning.
Me: So. You had very sick patient, the ER gave you a terrible handover and didn't tell you why they had intubated him, you were unsure of the diagnosis and you didn't call me. Why?
R1: I wanted to manage the patient on my own.
Me: But you were worried about them and didn't know what to do. In that case, you are supposed to call for help. If not me, then the staff.
R1: But I want to manage patients on my own.
Me: (murder eyes burning through his skull) But. You. Are. Not. Qualified. For. That. You are a junior resident who is supposed to be operating as part of a team, in a teaching hospital that spells out clear rules for when to seek help.
R1: I wanted to manage him on my own. And...I thought you might want to sleep???
Now that I am a senior resident, I want to be making decisions. I want the R1's to call me and tell me what they're thinking. I am comfortable making choices at 3am that affect patient outcomes. I am happier to be sleep deprived and thinking all night than sleeping in the call room.
I guess this is growing up?
As a side note, I also did a kick-ass thoracentesis and took a litre of fluid off an old dude's chest, allowing him to breathe without oxygen for the first time in weeks. It wasn't a totally terrible night.
When I was a first year resident, I would lie awake in my narrow bunk, praying that nobody would page me. Any night that I didn't make a decision was a good one.
Last night, I got called twice between midnight and 7am. This is unprecedented, especially for ICU call. The calls I got involved simple medication changes (labetolol, I love you) and clarification of nursing orders. I never got out of bed. At one point I thought, "This is weird. Maybe I should get up and check if everything's ok". But then I reassured myself that my phone and pager were both on and working, and pulled the covers tighter.
As it turns out, I was right to be suspicious. The junior resident HAD received a call, a consultation from ER. He had seen the patient, made some decisions about treatment and done admission orders. All of this would be fine, but he had done it without making a diagnosis. He approached the patient with a shotgun of drugs, all for different causes of respiratory failure, and gave them all.
I went over his decision making with him this morning.
Me: So. You had very sick patient, the ER gave you a terrible handover and didn't tell you why they had intubated him, you were unsure of the diagnosis and you didn't call me. Why?
R1: I wanted to manage the patient on my own.
Me: But you were worried about them and didn't know what to do. In that case, you are supposed to call for help. If not me, then the staff.
R1: But I want to manage patients on my own.
Me: (murder eyes burning through his skull) But. You. Are. Not. Qualified. For. That. You are a junior resident who is supposed to be operating as part of a team, in a teaching hospital that spells out clear rules for when to seek help.
R1: I wanted to manage him on my own. And...I thought you might want to sleep???
Now that I am a senior resident, I want to be making decisions. I want the R1's to call me and tell me what they're thinking. I am comfortable making choices at 3am that affect patient outcomes. I am happier to be sleep deprived and thinking all night than sleeping in the call room.
I guess this is growing up?
As a side note, I also did a kick-ass thoracentesis and took a litre of fluid off an old dude's chest, allowing him to breathe without oxygen for the first time in weeks. It wasn't a totally terrible night.
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