Over Night, Who is in charge?

I have started on the CCU which is an ICU for cardiac patients. It is a demanding rotation with long hours. It is a great learning opportunity and the patients are fairly sick. I am on call every 4 days. My nights on call it is just me and my senior resident taking care of all the CCU patients. We also admit any new patients coming in from the emergency department or other hospitals.

Overnight all kinds of things seem to happen to prevent sleep from occurring. I will get several pages from nurses with everything from; "can I give patient xyz a tylenol?" to "patient xyz is not breathing!" Generally I try to handle everything on my own allowing my senior resident to sleep. If I get something that I am not sure about or that requires additional hands then I will get my senior to help, teach, or explain. It can be very intimidating when you get a call to respond on a sick patient in a crisis. My first night on call I had 2 patients that were crashing and I had to manage their symptoms. As I responded to one patient who was having difficulty breathing. He was a 75 year old man with a recent MI where he had to be shocked and intubated and now was recovering. As I entered the room I saw that he was sweating, and sitting up in his bed trying to get the oxygen in and was struggling to do so.

It was 3:00 am and I was just hoping that he would not de-compensate to complete respiratory failure and or die. I sprung into action and position the patient in a manner that helped him to breath. I increased the oxygen level and administered some medication to calm him down because he was panicking and making it worse. I had the nurse get respiratory therapist to bring some breathing treatments. It was touch and go and I got the crash cart ready just incase I had to intubate the patient. The respiratory therapist showed up with breathing treatments and we started the nebulizer and the patient started to calm down and his airway opened up. He started to look better and I started to feel better and my heart rate slowed to a normal rhythm. The patient returned to his baseline and stabilized.

As I left the room with a sigh of relief and I was surprised at how in the heat of the moment the therapies and treatments just came to the forefront of my mind as I responded to the situation. It was reassuring to know that some of this stuff has stuck in my brain and is actually accessible when necessary. I feel like these experiences and situations each add to my training and hopefully help me become a better doctor. It is still very surreal to me that I am making the calls and the treatment plans on many of these patients. As a medical student you had some input but there was always filters and ultimately everything you did was reviewed and modified by a doctor before it went into action. It is a crazy feeling and makes me extra cautious/ even paranoid about making a mistake or not doing the right thing. As a resident physician you always have access to help from an attending physician or a senior resident to help if you are stuck or do not know what to do but often you are expected to be able to handle a lot of the cases without help.

I have been thrown into the ocean and it is sink or swim. It is a good thing I like swimming.