The night of 4 rice krispie treats.
This past saturday was my most hellacious call yet. It required multiple trips to the residents lounge for sustinence, aka rice krispy treats. By the title, you can ascertain that there was not a whole lot of time for breathers, let alone any square meals... although.. rice krispy treats are rather square..hmmmm.
Why was it so bad, you ask?
First of all, I received sign out at about noon from 3 other interns and these are a VERY FEW of the patients they signed out to me:
1. a lady with a sodium of 119, who was symptomatic, although not seizing yet. What did they do for her? Oh, held fluids and had me watch sodiums q 4 hours. No instructions about what to do if they didn't go up. Of course, they trended down. I spent a bunch of my time researching this online, and this is what I found out. Apparently, you either restrict fluids or start them after a bunch of other labs are back, like serum osmolality, serum urine, and urine sodium. So I had to run these labs too, check them and then take her off of fluid restriction and start fluids. sheesh, like I didn't have other things to do, for instance:
2. This guy had septic arthritis in 2 joints, kidney failure and liver failure (thank you IV drug abuse, whose glad they went into peds?) then developed abdominal pain. THis is what they signed out to me: If CT shows perforation, call surgery. If it shows ascites, call IR for drainage. So I was running around all night, trying to keep this guys pain under control, tracking down all of these consultants, and since he had a new acetabular hip fracture around a prosthesis, with a hematoma, calling ortho. I called IR for his ascites, ID for his colitis since he was already on IV Abx, and prayed he wouldn't need to be coded.
3. I admitted a 97 year old lady with new onset a fib, which is an admission I know well and can do. I went and saw her, spoke with her and her family, watched her get up and walk to the restroom, then went to discuss the plan with my resident. The ER had started IV fluids, but I didn't really think about it. By the time we got to seeing her on the floor she was in fulminant heart failure. My resident said to me, "you know, if there is a patient you even think is sick, you need to tell me right away so we can get orders in." I just wanted to scream, YES, I know this! I'm not retarded. She DID NOT look like that when I saw her previously. I know these things happen, and normally my resident is very sweet, but I just hated her condescending tone.
4. One of my patients was Post-Op day #7 from small bowel resection, then developed severe abdominal pain. Went to see him and he is writhing and screaming in pain, with an erythematous and PURULENT (not the other word, meaning filled with pus), wound. Gave him more pain meds, took cultures and started abx.
Between all of this, I had to admit 5 patients, do H and Ps, orders, and deal with other (less urgent) cross cover calls etc. So I tried to do my best but every once in a while, I would over look an order: daily labs, GI prophylaxis, forgetting to replace magnesium etc. Things I should do, and I know to do, but with all the stress, I wasn't as through as I should have been. My resident said things like, "Is there any reason why there aren't daily labs on this patient? We order labs on everyone every day."
I sucked up the first few comments, but between the stress, being overtired and PMS-ing, I did what I do best: I cried. My resident was very apologetic and told me I was doing a good job, but once the tears started they didn't stop. I wasn't sobbing or anything, just couldn't shut off the tears. SO EMBARASSING. I was having flash back to third year when another student on service was always trying to show me up, knowing more about my patients than I did adn then chiming in during rounds, citing studies, general sucking up, etc. The water works came back then too.
All this crying and there wasn't even a wedding involved. Watch out, Lace, there may be a flood next May!
Why was it so bad, you ask?
First of all, I received sign out at about noon from 3 other interns and these are a VERY FEW of the patients they signed out to me:
1. a lady with a sodium of 119, who was symptomatic, although not seizing yet. What did they do for her? Oh, held fluids and had me watch sodiums q 4 hours. No instructions about what to do if they didn't go up. Of course, they trended down. I spent a bunch of my time researching this online, and this is what I found out. Apparently, you either restrict fluids or start them after a bunch of other labs are back, like serum osmolality, serum urine, and urine sodium. So I had to run these labs too, check them and then take her off of fluid restriction and start fluids. sheesh, like I didn't have other things to do, for instance:
2. This guy had septic arthritis in 2 joints, kidney failure and liver failure (thank you IV drug abuse, whose glad they went into peds?) then developed abdominal pain. THis is what they signed out to me: If CT shows perforation, call surgery. If it shows ascites, call IR for drainage. So I was running around all night, trying to keep this guys pain under control, tracking down all of these consultants, and since he had a new acetabular hip fracture around a prosthesis, with a hematoma, calling ortho. I called IR for his ascites, ID for his colitis since he was already on IV Abx, and prayed he wouldn't need to be coded.
3. I admitted a 97 year old lady with new onset a fib, which is an admission I know well and can do. I went and saw her, spoke with her and her family, watched her get up and walk to the restroom, then went to discuss the plan with my resident. The ER had started IV fluids, but I didn't really think about it. By the time we got to seeing her on the floor she was in fulminant heart failure. My resident said to me, "you know, if there is a patient you even think is sick, you need to tell me right away so we can get orders in." I just wanted to scream, YES, I know this! I'm not retarded. She DID NOT look like that when I saw her previously. I know these things happen, and normally my resident is very sweet, but I just hated her condescending tone.
4. One of my patients was Post-Op day #7 from small bowel resection, then developed severe abdominal pain. Went to see him and he is writhing and screaming in pain, with an erythematous and PURULENT (not the other word, meaning filled with pus), wound. Gave him more pain meds, took cultures and started abx.
Between all of this, I had to admit 5 patients, do H and Ps, orders, and deal with other (less urgent) cross cover calls etc. So I tried to do my best but every once in a while, I would over look an order: daily labs, GI prophylaxis, forgetting to replace magnesium etc. Things I should do, and I know to do, but with all the stress, I wasn't as through as I should have been. My resident said things like, "Is there any reason why there aren't daily labs on this patient? We order labs on everyone every day."
I sucked up the first few comments, but between the stress, being overtired and PMS-ing, I did what I do best: I cried. My resident was very apologetic and told me I was doing a good job, but once the tears started they didn't stop. I wasn't sobbing or anything, just couldn't shut off the tears. SO EMBARASSING. I was having flash back to third year when another student on service was always trying to show me up, knowing more about my patients than I did adn then chiming in during rounds, citing studies, general sucking up, etc. The water works came back then too.
All this crying and there wasn't even a wedding involved. Watch out, Lace, there may be a flood next May!