Here’s a snapshot of what I’ve been doing at 0500 on my call nights:
1. Trying to figure out why my patient suddenly dropped his oxygen saturations, increased his intracranial pressures and became non-responsive. The respiratory therapist did a great job of bagging him until the anesthesiology resident came up an hour and a half later (!!!) and exchanged out his mucus plugged endotrachial tube.
2. Declaring a patient dead.
3. Admitting a transfer patient that nobody told me about. They always come in sicker when they are surprises.
4. Fixing electrolyte abnormalities, following up on blood gases, worrying about why the hemoglobin had gone down.
5. Answering pages from the answering service and arguing with patients that no, I’m NOT going to make a refer to a private hospital in NYC, just because you feel you can’t possibly walk into an ER there (that was a few weeks ago, I’m still beyond angry about the insufferable selfishness and lack of personal responsibility that some people possess)
6. Discussing with the ER why I’m not going to come down and see a patient, when the radiology resident over-called a head scan for a patient who had no new symptoms.
7. Napping. (I hesitate to call it sleep when the pager is going off every 15-20 minutes)
At 0500, I am tired. I am exhausted. At that point, I have worked 22 hours with another 6-8 to go. I lose the ability to multitask and can only concentrate on the thing right in front of me. Things have a tendency to crumble at 0500 in the morning. I have coded more patients than I can count at 0500. It can be utter chaos and like most things in the ICU, completely unpredictable! Two nights ago, I was balancing why another patient had suddenly increased ICPs and was trying to manage that, in between putting in a subclavian line at midnight (another rant that I’ll spare you) and adjusting another patient’s ventilation settings. It was a relative light night. I only had 6 patients of whom I was taking care, but I still didn’t get any sleep until 2 and that was punctuated by frequent calls from nursing.
It is because of that, because of all of the above reasons, that when the patient rolled in at 10:30 at night, and when we all decided that the patient wasn’t quick sick enough to warrant a middle of the night procedure, and when the attending asked me to page everybody under the sun at 0500 exactly for a procedure at 0600, I decided that it would be best that I inform the fellow of the changed plans (it was supposed to be an urgent in-the-middle-of-the-night case, but the patient was stable enough to wait a few hours) and have him page everybody instead. It is, after all, HIS responsibility and it was at 10:45 at night (plenty of forewarning) and he had to be up and here anyway to get everything going for the case and who knew how my night was going to go.
So when the fellow doesn’t page anybody and shows up 3 hours late, guess who’s fault it is. Or when the tech comes in and can’t find the order for the procedure, guess who’s fault it is. And when anesthesiology doesn’t take the patient until 8 in the morning, because the fellow isn’t there to get consent, guess who’s fault it is. Never mind that when I called the nurse at 0530 in the morning to check up on the patient, and found out that nobody had been by to see the patient, I had everybody paged to remind them (it was the first page received because “the fellow didn’t get my page” from the night before. Bull crap. The pages are trackable, moron.) Never mind that I had let the operating room know before the patient was even admitted. Never mind that I had orders done, the patient seen, examined, story straightened out, blood pressure controlled, and the attending notified within a half hour of coming from the outside hospital.
I was yelled at, chewed apart by four different people that morning, for “slacking on my duties.” By the last one, when the attending was telling me that he’s not mad, but just disappointed in me, I was bawling, sobbing in the critical care unit. Control of my emotions is not one of my strong points post call.
The attending, one of my favorites which is why it hit me so hard, brought me up orange juice as an apology (although he really didn’t apologize – I think I just shocked him by the tears). And in the staff meeting today, apparently “things were clarified” and “it wasn’t [my] fault” and I am a “good resident.” So maybe a little vindication.
I’m still pissed off about it. (I moved beyond emotional once I got some sleep). I’m tired of being treated like a secretary. No, I’m tired of being treated like a lazy secretary, without any acknowledgment of the hard work that I’m doing.
I’m tired.
Two days ago, I had come to the decision that I was going to throw in the towel, and admit to myself what I’ve known for the last three years (but didn’t really want to admit because it’s going to be more hard work, and research projects and more CVs and applications and The Match all over again and did I really want that drama). I want to do critical care. I want to do neuro critical care (still trying to figure out the general part, but that’s even more complicated). And I kinda wanted to stay here, mostly because I’m not super competitive, I don’t believe in the nonsense that you have to go to the big name hospitals to get good training, and I rather like every body that I work with. I have a great rapport with most of the nurses, the nurse practitioners are fabulous, the attendings are good teachers, etc.
And now. This.
Hahahahahahahahaha. Ha.
![[info]](http://stat.livejournal.com/img/userinfo.gif){kind=small}
