On-call, post-call, pre-call

When you're on call every third night, you're always either on-call, post-call, or pre-call. So I was on-call Sunday night. Things started pretty slowly--we had rounds, wrote our notes, and then kicked back and watched our patients and waited for the pages to start coming in. There were a few random pages about fairly simple problems throughout the afternoon, but nothing that took any longer than a few minutes at a time to deal with, so I was starting to get bored. I spent a lot of time in the transition year call room, where two of my fellow transition year interns (one pre-anesthesia, who is in the cardiac care unit, and one pre-physical medicine and rehab, who is on OB/GYN) were also hanging out with their equally slow afternoons. I discovered the hospital cafeteria doesn't have anything good on the weekends (when Subway is closed), and was going to order pizza with the internal medicine interns on call, but we were too late on the uptake (pizza place closed at nine, and we didn't think about it until 8:50). Then, right at nine, my resident paged me and told me to get to the ER, and things went non-stop from there.

Two unresponsive patients came in within five minutes of each other, which is never a pleasant situation. One just had surgery three days before, so the surgery team came and handled him and ended up taking him to the SICU (surgical intensive care unit). The other had been in asystole (flat line) or PEA (pulse less electrical activity; electrical impulses go through the heart, but it can't contract enough to push blood through the body) for 45 minutes, which is a pretty bad situation. We ended up getting a pulse again and getting him on the ventilator before moving him up to the MICU, where they had to get him somewhat settled in before going down for a head CT. Since I knew that that would take an hour or so, and it was already 1:45am, I reminded the nurses to page me when they were ready and went to lie down in the MICU call room. Then an hour later, it was time to take him to CT (with me ventilating with the bag-valve-mask as we rolled him down the hall and into the elevator), and then back up to the floor. The whole process took about an hour to get a five minute head CT (which was pretty ominous looking when we saw it at rounds on Monday morning). Then when I got back, I had to deal with being sleep-deprived and trying to explain the events of the night to the family. It wasn't until I finally got to lie down again that I realized how scary this must be for them; for me, it was another random unresponsive victim who came in and will never wake up. For them, a few hours before, he was walking around and talking, and now he's in the ICU, on a ventilator and all sorts of IVs, and some doctor they've never met is trying to tell them bad the situation is.

It was a banner night. Then I went back to bed until the pages with the morning lab values started coming in.

At rounds on Monday, I was grilled about the electrolyte abnormalities in the acute kidney failure of one of my patients (and stumbled through the answers), and then after writing my notes, was out of there. I decided to hit the base gym before going home, which was a really good idea--it completely woke me up so I could drive home. Then I made lunch, did some cleaning, and went down to the pool, where I promptly fell asleep. I probably would have stayed that way (ending up rather burnt) if one of the general surgery interns hadn't paged me asking if I wanted to do dinner. So I changed, took the Metro into Bethesda, and enjoyed the 1/2 priced bottles of wine at Olazzo (their Monday happy hour special) with some surgery interns (I spend a lot of time hanging out with surgeons, for some reason). And then it was back home, where I went to bed early in anticipation of getting up to go in for a "work day" today.

"Work day" means you go in, see your patients, learn everything that's happened to them in the last 24 hours, and then round (which took forever today, for some reason, but I did get to look impressive by properly interpreting an EKG), and then write notes and get to noon conference (which was cancelled today). After leaving the hospital, I met with one of the fourth year preventive medicine residents about on-going research projects that I could join, and then headed home for a run. I've just been lounging around since, will probably go to bed early again tonight, because I'm pre-call.