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Another Night of Call, ICU

These are the details of one night, one call in the Medical ICU.  I happened to be on call overnight for the Medical ICU and my day started about 4:00 in the morning.  I arrived to round on some of my patients that I had been following in the ICU.  I think I had three or four patients that I was following, all relatively sick.  One patient with advanced end stage metastatic cancer.  

Another patient who was on a ventilator with end stage liver disease, alcoholism, portal hypertension and bleeding varices which are veins on the esophagus near the stomach and the esophagus where they meet and those have a tendency to bleed and they bleed profusely and patients often bleed out and die.  Then I had another patient who was for all intents and purposes brain dead on full life support while family was trying to determine what they should do or if they should do anything to prolong the patient’s existence.  There was no way to really prolong life because the patient wasn’t that brain dead, and then I had another patient who was there on a ventilator who had had acute respiratory failure and the complications that go along with that.  

So I was rounding on those patients and seeing how they did and adjusting medications, adjusting vent settings and gathering data from the night before, and so my day started at 4:00 in the morning in rounding on those patients, and throughout the day, like from 4:00 in the morning until 5:00 at night I continued to manage those patients, take care of those patients and other patients that we had on the unit which entailed calling specialists, again changing medications, ordering different imaging tests or different diagnostic tests on the patient.  Around 5:00 I began to take calls so at about 13 hours into my day I start taking calls, so all the other residents and physicians go home for dinner.  I stayed and for the night and I stayed at the hospital on the ICU and begin to take call.  

The night started rather swell.  I didn’t have a lot of calls to begin with as far as admitting new patients.  Mostly just calls on the patients who were already on the floor, from the nurses maybe asking me to come and examine the patient because they looked they were getting worse or questions about can we give the patient this kind of medication, or oh, the patient’s blood pressure is low and it’s time for their blood pressure medication.  Should we hold the medication and these kind of things, and those kind of not swell enough to where I could go to bed and not busy enough where I felt like I was hurried and running around.  

Then about 8:00 at night, shortly after a shift change of the nurses, they change at 7:00 at night, things really started getting crazy.  So like I don’t know if it was my lucky day but the ER was extraordinarily busy and patients who were already on the floor seemed to be getting sick and we had a lot of open beds in the ICU and the patients just started coming one after another.  I had, now when you’re on the ICU those beds are held for very, very sick patients, but as the hospital fills up and all the other floors become full, you still have beds at the ICU that are available, often times you might fill those beds with what we call Kelly boarding patients.  So these are patients who may not normally be full fledged ICU but need to be monitored for heart problems or potential heart problems and the floor telemetry where they normally go is full and you start getting boarding patients and I started to get some of these kind of patients so the telemetry unit filled up pretty quick, and telemetry unit is a unit that monitors the heart constantly.  

Of course on the ICU we monitor the heart constantly but we’re also monitoring other things.  So my first patient was a patient who had been sober for several years.  Decided to start drinking again.  Went on a bender and was found unconscious in the street.  Brought into the emergency department and began vomiting copious amounts of blood, coffee ground emesis and because he was losing blood very quickly he began to bleed out in the ED.  They stabilized the patient and gave the patient blood.  Got him kind of maintained safe level and then transferred him up to me in the ICU where I continued the management, giving more blood and actually put in a central line in the patient, and right as I was admitting that patient, got another patient who had a third degree AV block which is an emergency.  The  heart is blocked and the patient in need of temporary pacing for their heart so they can get a full pacemaker, and so that entailed, I got the patient up on the floor and put in a central line or I put in a line to the internal carotid artery and fed that catheter if you will down right down about to the heart, just into the heart, and it was a triple lumen catheter and I called cardiology fellow then came over once I had the line in and we put in an intravenous pacer.  So it’s a little heart pacemaker that is temporary.  It would get in through the catheter I put in and into the heart and then pace the heart, and these are always tenuous situations because a patient’s heart is to the point where it can give out at any moment and until you get that line in and the pacing in you’re kind of on pins and needles because the pacing pads that you have on are not the greatest pacing pads and really it’s touch and go, so it’s kind of a very careful hurried insertion of a line and getting the  pacer and so I paged the fellow.  Let him know I was starting the central line.  Got the line in.  He showed up and together he let me put the transvenous pacer in and we got that patient stabilized and it seemed while I was doing that two more patients started coming to the floor and so it was like this for several hours.  Just like a crazy busy night.  

On top of that I had several of the patients who were already there have problems and needing attention and was getting called by the nurses at all times.  So the night just continued to go and by the time I was able to actually take a moment to breath and go to the bathroom, I looked at the clock and realized it was 4:00 in the morning.  So I had been there a full 24 hours at that point, and had two more patients coming up.  So by the time I finished my call at nearly 7:00 in the morning I had admitted nine patients overnight as a load as far as the covering the ICU and I couldn’t even count how many other orders or things I did to manage the existing patients.  I was beat.  I think it was a record; an intern admitting nine patients overnight in the ICU and several procedures.  Nobody died and it was a successful night from that standpoint.  Many patients got better, but about 7:00 I finished my call and the other physicians started coming in, and I went back to managing the patients that I was directly in charge of, and rounding with the attending physician and the morning went on with managing just my patients and also signing out or telling the other physicians coming in about the patients I admitted and who would take those patients, the nine patients I admitted, and all in all that took me up until about noon or so, and then I was post-call and able to leave.  So that was by far the most busy night I’ve ever had.  It was go, go, go, very sick patients, lots of procedures and not a lot of downtime so it was kind of a crazy night.  

So obviously I’m not going into all of the nine patients that I admitted but needless to say they were very sick and so quite an experience and when I finished I felt pretty good that oh, gee, I can handle these very sick patients and I was fortunate and lucky enough that I was able to avoid any disasters or near disasters and got through the night, but I do not want another night like that to occur ever again if possible but I’m sure it will, and that was my call in the ICU.