My post-callness

Being post-call is kinda nice, if you ignore the whole being-completely-exhausted thing. Actually, last night wasn't too bad. I went to bed a little after midnight, and didn't get any pages until about five. It was so strange that I asked the intern I was working with if nurses were bypassing me and paging him directly, but he said that he thought I was just doing a good job of triaging pages and didn't need his help.

I did get one page that turned out to be a problem, the one right before midnight. A nurse paged me saying that one of our patients was spiking a fever, which was new, and rather worrisome considering the fact that he was already on two broad-spectrum antibiotics. He has a spinal abscess (blog of infection on his spine) that was biopsied yesterday afternoon, so I was imaging all these scenarios of bacteria spreading throughout his bloodstream and him becoming septic. So I asked the nurse for the rest of his vitals, which were vastly different than his previous vitals, and really made it look like he was septic. So I told her that I would be ordering a fever workup (blood cultures, urine culture, chest x-ray) and that I'd be up to see him in a few minutes. I called the intern, who agreed and told me to add a bolus of fluids (one liter of normal saline in an hour), and said that he would co-sign the orders as soon as he was done admitting a patient to another service.

So I went to the patient's room, and found him sleeping rather comfortably. Confused, I checked his vitals chart, and everything was completely normal. So I tracked down the nurse and asked her what was going on, and she was rather confused by the normal vitals as well. So I found the PCA (the person taking the vitals; don't ask me what it stands for, because I don't know), and he confirmed that my patient's vitals were normal last time he checked. I decided to check the vitals sheets on the other patients in the room, and discovered that a roommate had a fever and the vital signs that the nurse read to me. I informed her of the error and called the intern and told him to cancel the fever work-up and explained the situation.

So this morning, I talked to my intern and told him what happened, and we decided that even though nothing happened, I should write up an incident report. It's not tattling on the nurse, but simply pointing out a 'near miss'. If I hadn't been on, the page would have gone to the intern, who would have ordered the same workup. But he wouldn't have seen the patient for at least half an hour, until he was done admitting the other patient, and by then, the fever work-up would have been done for nothing. This kind of things are how medical errors happen.

Anyway, after that whole debacle, I came home, crashed for about an hour, and ran all the errands I don't have time to run any other time. Not quite relaxing, but I did get a lot accomplished, so I guess that makes up for it.