It's true. I'm on my medical ICU rotation right now (MICU) and I'm on overnight call every 4th night. I usually sleep for 2-3 hours a night when I'm on, and then go home at 12 or 1 the following afternoon. That adds up to about 30 hours on at once, which happens every 4 nights so I work about 75-80 hours a week. This is a foreshadowing of internship. I have had two firsts for my medical career during this rotation.
Last tuesday night, we got a transfer from an outside hospital. It was an 84 year old lady with a history of small bowel obstruction, dementia, and coronary artery disease. She arrived on a levophed drip (powerful vasoconstrictive medication for maintenance of blood pressure), and intubated. Her family had allegedly retracted her DNR status and now wanted a full court press. We were barely able to get a femoral arterial line in, and when we checked the CT from the outside hospital, it confirmed our clinical suspicion that the bulk of her bowel was dead. Surgery was reluctant to take her to the OR, for the obvious reason that she would likely not survive her operation. We contacted her family and they informed us that they wished us to withdraw care, which we did. She expired about 10 minutes later as we watched.
Four nights ago we received a call that one of our patients was seizing, had probably aspirated, and was now becoming bradycardic (her heart was slowing). We ran upstairs, started bag masking her, and had to begin CPR. After several rounds of vasoactive drugs, her heart actualy started beating again and she returned to her baseline, which was incredible. This was my first experience in a code and I'm glad that I did 6 weeks of anesthesia to practice bag masking pt's, since that was my job.
MICU has been quite intense, that's for sure. I do enjoy the complexity of these patients, but caring for them is like trying to replace the transmission in a truck, at night, by flashlight, at gunpoint, when you're a bicycle mechanic. It's really hard for me to see the big picture, I can spot many of the abnormalities, and piece some of the parts together, but placing all of them together as part of a coherent whole is far beyond my current knowledge base.
Spiff.
2 comments:
I remember my first code. I was responsible for performing chest compressions on the guy after the medics brought him in. It was gross because the medics had busted his ribs and I could feel the bones crunching. It was awful because you could tell he was dead and not coming back. I'm glad your experience had a more positive outcome.
eeek! Sounds intense.
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