a mismash of emotions

I was on call again the other day (do I do anything else?) for the ICU. The evening started with the realization that my husband (best friend and life partner) was also on call, but for Anesthesia. I was called early in the evening about a young woman who had overdosed and needed to be intubated. As I was rounding the corner to the ER, the door to the OR opens and who walks out? My husband! I knew what he was doing - he thought he was going to get to intubate this girl. Not if I could help it, and get there first!! So, we ran down the hall (laughing) to be the first one there. He let me go ahead - let the "junior" have a chance. He kept calling me "Dr. McBain" until finally I said, "I like that, can you call me that at home?". He said, "sure, Dr. McBain it is your turn to take out the garbage!" Smart ass. So that part of the night was fun. (yes I really am a geek if I found that fun. What can I say, I like my job for the most part, and sharing it with my favorite person is even better.)

The night started to get long when I kept getting paged about one patient. A man who had heart surgery and wasn't doing too well. We were having a lot of problems with his blood pressure. He also went into Atrial fibrillation so we started some Amiodarone.

Then I laid down to sleep for a bit. It was about 2:00 in the morning. All of the sudden I am awoken from my slumber with a soft knock at my call room door. I opened up the door, and who did I see? My husband! He had come to cuddle for a bit! We have never done that before, but let me tell you, the minute he climbed in, I was fast asleep. My own personal teddy bear!

Alas, it didn't last too long. About a half hour later my pager went off and I was asked to see a patient for preop assessment. This guy had an incarcerated hernia, but MAJOR heart problems and acute renal failure. My husband was also paged for the same guy (what a team we make!), about 5 minutes later. That was the end of our little liason, as the patient was going to have to go to the OR in a couple of hours. The patient was OK at present, but who knew if the stress of surgery would be enough to put him over the edge?

So, back to my bed for a little nap interrupted with calls about blood pressure, and low heart rates. Suddenly, it is 5:30 in the morning and I get a call to come to one of the rooms right away. I walk into the ICU and see a "Code" in process. The reason that I didn't hear it overhead is that the ICU runs their own codes. There was already someone running it when I got there. I just stood in the back and shouted out suggestions. I felt completely useless. Then I had to call my attending and the cardiac surgeon and let them know what had happened. It was the same man who I had been dealing with all night. Sort of frustrating, and depressing, but not too much I could really do. We did manage to get him back, at least for another 12 hours (he coded again later the next evening, again pulled through).

I like the ICU. I like what I do, but I hate the nights. I feel like too much of this would end up kililng me. At the very least make me completely depressed and hate my life. All would be good if I didn't have to do call.
At least I learn a lot at night.

first dictation

So, I had to dictate today. You are probably thinking, so what? No big deal, right. Well, the only reason that you ever have to dictate in the ICU is if you transfer someone to another institution, or (more commonly) you transfer someone out of the ICU PERMENANTLY (i.e. transferring them to the ICU in the sky).
We had a family meeting today with one of our patients. It was decided at the meeting that the patient wouldn't really have wanted to live like this and had actually expressed so to his family before all this happened. The patient was also able to communicate his wishes. So, we took out the endotracheal tube, and within mere minutes he was gone.
I was asked to "pronounce" the patient. I have never had to do that before. I have only read about it and knew the basics (no heart beat, no respirations, pupils fixed and dilated, no blood pressure, no response to pain). Pretty straight forward. The problem here was that on the monitor the pacemaker was still running, so it looked like his heart was beating. However, if you listened there was no heartbeat. Kind of wierded me out. I thought that it had to be turned off before I could really pronounce him, but apparently not. My attending said that if you were to go to the cemetary, there would be lots of pacemakers clicking away. That also weirded me out. In fact, the whole experience of "pronouncing" the patient creeped me out a little. The patient had just died and so was still warm, but looked dead, and had no signs of life on examination. I think it was the body temperature that was the most disturbing. Dead people are supposed to be cold.
Anyway, the dictation is done, although not very eloquently. Now the family can begin the grieving process.

Scariest day in ICU

So, it is my first time in ICU. The first few times I was on call were pretty quiet. A few calls about low potassiums and low blood pressures, but nothing really exciting. I kept waiting for the crap to hit the fan. A few days ago it did. Was called to see a man who we had been asked to see earlier in the day. At that time, he didn't "qualify" for the ICU (i.e. didn't need intubation). When I got up there he was acutely distressed, much more tachypneic, diaphoretic, and generally looking SICK. I paged my attending, but it was too late - he coded in front of my eyes. Haven't had a code blue on the ward yet. Different than the ones in the ER. No one seems to know where anything is, and so it takes a LONG time to get anything. Maybe it just seems like a long time when everything is in slow motion. Amazing though, I seemed to know just what to do. This guy needed to be tubed, and now. Finally, after bagging him I got the supplies that I needed and was able to intubate him. The guy was big, so I was worried I might not be able to get the tube in, but no problem.
Then down to the unit for an art line, and a central line. We put in the introducer for the CVL, and initially I had problems with the wire, but eventually got the line into the IJV.
Several hours later I was called about the same man. His sats were dropping, ventilation pressures were increasing, and there was no air entry on the entire right side. Oh crap. The entire lung was collapsed. This guy needed a chest tube, and it was my fault. My beautiful (although lengthy) central line caused a tension pneumothorax. The problem was, I had only ever put in one chest tube. I needed help. My attending told me to "get started" and that he would be right in.
So, I gowned up and got ready. Prepped the patient, put in some freezing and got ready to slice.... Amazing how easy a chest tube is in retrospect. I did have some talking through, but it went smoother than I thought.
Now that I have done everything that I was afraid of in one night in the ICU, I can sleep better at night. Hopefully, the next few nights will be back to the way it was before - quiet. That is how I like it.

first timer

Just trying out this "blog thing" for the first time. We'll see how it goes. Thought this would be a great way to express some of the stuff that goes on in my life as a resident. Stressful some times. Fun, lots of times. Rewarding some times. Wouldn't go through it all again, wouldn't trade it for the world. Thought someone might read this and agree with what I have to say, or, at the very least, find it interesting. Again, we'll see.