Saturday, October 24, 2009

Has It Really Been This Long?

I promise - I have a very good excuse for why I have taken THIS LONG to post.

I've been on Block Nights for the whole month of October. I've been counting down the days since the first night shift I worked. Did you read the blog I posted a while back about being House Officer? Well, during the Block Night rotation, it means that I am H.O. EVERY NIGHT OF THE WHOLE DANG WEEK......

It means that I am in charge of everything that goes down in the hospital. Someone has a fever? Page me. Someone throwing up? Page me. Some old, frail person fall? Page me. Someone's heart stopped beating? Call CODE BLUE first. Don't worry about paging me...I'll be there. Someone needs to be admitted from the ER? Page me. Talk about responsibility! I'm left to deal with patients I have never seen, patients whose medical history I don't know..... And I'm relied upon by all the attending physicians in the hospital to keep their patients alive while they themselves can't be in the hospital. It is stressful!!!

Last week, on what could have been - actually it was, the worst shift of the entire month - I was called by a nurse to check on a patient who wasn't breathing very well.

RN: Doctor, can you come look at this patient? When he has his oxygen mask on, his O2 sat (Oxygen saturation of the blood) is 98%. But he keeps pulling off his mask and it drops to the 70's.

ME: Sure, I'll come take a look at him.

***What I see when I walk into the room: The patient appears to be sleeping...with his oxygen mask down on his chin. There is a tech sitting at the bedside - I assume he's there to prevent the patient from pulling off his mask. (Apparently not paying attention to the fact that the mask was around the guy's chin!)

ME: Well, let's start with putting the mask where it should be. And let's get an accurate pulse ox (the device that measures oxygen saturation).

TECH: Yes, the respiratory team had a tough time getting a good read on him earlier.

ME: (Thinking in my head): Oh boy.
****Tap patient on the shoulder*****
ME: Sir?
****No response****
****Shake patient's shoulder****
****No response****
****Sternal rub****
ME: SIR!!!!!
****No response****
ME: Okay. Please go call a RAPID RESPONSE.

TECH: On my way.

Please note that the RN who originally called me about this patient was no where to be found.

Long story short, I ended up having to intubate the guy (stick tube down throat so he could breath) and transferred him to the ICU. This was all while I was receiving pages from the ER for more admits......yikes!

And here was the page I received last night:

NURSE: Um, doctor? This patient you admitted with COPD exacerbation sounds really tight...but you didn't order any breathing treatments.
ME: Yes I did. Did you look at the orders?
NURSE: No, but the respiratory team told me.
ME: I wouldn't have admitted someone with COPD exacerbation without ordering breathing treatments. I swear I ordered them for this patient. Do you have the chart?
ME: Can you turn to the orders, please?
NURSE: Yes. Oh, here it is. Yes you did order it. Sorry.
ME: Thought so.