The hardest phone call i've ever had to make

I wish I could only blog funny things, but the truth is, more times than not, our job isn't always humorous.  The reason I am sharing this story with you is because it has been on my mind the last few days. 
I am on night float now.  I work every night starting at 7PM till the next morning around 8 AM.  I then try to sleep for most of the day to just come back that same night at 7PM and do it again.  Yes my schedule may be all out of whack and I don't get to see my husband or my new adorable puppies, but working nights has its perks...you don't have to deal with social work bullshit i.e patient placement, nursing home paperwork, transportation forms, etc; you don't have to write patient notes, or admit patients.  On night float I just deal with any acute complaints or emergencies pertaining to the patients I am covering overnight. 

Just a little background: every night when I come to the hospital I get checkout, which is a list of the patients and their active medical problems, medications, and things that need to be checked or followed up on overnight.  Some nights the checkout will say "watch this guy closely, he looks sick, he could die."  Or if the primary team thinks a patient is close to death they write the top 3 most likely causes of death on their checkout as to help facilitate my filling out of the death summary.  Most patients are just fine and getting routine medical treatment and the checkout says NTD (nothing to do), meaning they are stable and the team doesn't forsee any acute events happening overnight.  That was the case for this particular patient on this particular night. 

The patient had just been admitted earlier that day for pneumonia.  His checkout said, patient recieving IV antibiotics, breathing treatments, and steroids, but most importantly there was NTD.  At about 12 am my pager goes off, "code 99" (meaning patient was unresponsive/cardiac arrest and requiring CPR).  I run up to the 6th floor to find this patient being coded, with a nurse above his chest applying chest compressions, the other doctors and I frantically yet methodically clinically evaluating him, ordering meds, and assessing his cardiac rhythm.  Only problem, there wasn't one. Shortly after the code, I physically examined the patients cold and lifeless body and pronounced him dead. As I walked back to the resident work room, I had a profound all consuming sadness in my heart because I knew what had to happen next...contact the family.  At this point it was 12:30 AM and I was getting ready to make the hardest phone call of my life, I had to call his wife. Before picking up the phone and dialing the 10-digits that would soon change this woman's life I burst into tears.  I could not imagine being on the other end of that phone call.  Just that morning she had dropped off her husband for what she thought was a simple case of pneumonia, not realizing that when she left for the night that would be the last time she saw her husband alive.  I took a deep breath and brushed aside my own personal anxiety and trepidations and called the wife.  As soon as her and her daughter made it into the hospital, the daughter asked me in tears, "I bet this was the hardest phone call you have ever had to make?"  Indeed it was.  I then too began to cry alongside the family.  The daughter then said, "You doctors are human too." Another truth.

Bottom line: Events like this help put life back into perspective by reminding you what truly is important.   To me it is family and loved ones.  You forget about all the petty shit...the stain on the carpet, the laundry, the bills, the roof leak, the studying, the disagreement with a loved one...and refocus on the things that really matter to you.  So, appreciate your family, your friends, and no matter how tired, how mad, or how overworked you may be feeling, make every effort to be there for them and always tell them how much you love them!  If you are reading this blog you are probably a family member or a close friend and I want you to know that I love you! 

What would you do to get out of prison?

Look closely...what do you see?  Look again. 
This wasn't my personal patient, but a friend of mines.  The patient came in with nausea, vomiting, and abdominal pain.  hmmm....I wonder why?  He swallowed a screw (which you can see on the left side) and two batteries (which you can see in the middle of the film).  He wanted an escape route out of the R. county prison and went to great lengths to ensure it ended him up in a better place....the hospital, with a dentist as his doctor. haha.  I am serious.  The dental residents have to do shifts in the emergency room.  Honestly, that would be like asking me to do a root canal, or quote lines from movies, or not interrupt in the middle of a conversation...nearly impossible. Even though seemingly odd, a dentist in the ER, it did lend to many hilarious stories.   This being one of them.  It's ironic, because I do everything I can to get out of the hospital, and this guy did everything he could to get himself admitted.  Maybe life is not that bad. 

Not just in hollywood

My husband and I recently watched a stupidly funny movie- Hall Pass, in which there is one scene where the female character is having diffuse abdominal pain, then sneezes, sharts, and abdominal pain resolves.   I recently learned that sharting (made famous by Philip Seymour Hoffman in Along Came Polly)  isn’t something that only happens in the movies. 

Sharting is exactly what it is sounds like.  I don’t think I need to elaborate on that explanation ;)  It was 6pm, I was getting ready to leave the hospital, when I received a page from one of the nurses claiming that one of my patients needs to be seen because he thinks he is in Russia.  He was completely clear headed and oriented on admission.  Was he getting sicker?  Did I give him a medication that gave him altered mental status? 

I walk into the patient’s room to find him sitting up in the chair with only an adult diaper on.  His hair completely disheveled and sticking straight up defying gravity by some means I don’t understand, because had no access to hair gel.  He was ranting about how ridiculous it was for us to keep him in the hospital while he was in Russia and he needed to get out!!  He kept claiming there were men after him and he needed to get out into Russia.    I started to assess the patient.  I asked the nurses to get vitals on him as I examined him.  He continued to rant and rave about Russia.  When all the sudden there was silence.  Everyone stopped what they were doing and starred at the patient.  He had a puzzled look on his face.  The patient lets out a big fart.  Thinking it was nothing but a fart I continue with my physical exam and exploring the cause if his altered mental status.  When all the sudden he shouts, “I am sitting in shit!”  “I took a shit in my pants.”

I step away from the patient to find a small amount of runny brown liquid dripping from the edge of the seat he was sitting in.  I guess a “shit in his pants” was all he needed to slap his back into reality.  After the “shart” he was completely back to his normal self.  We sat and talked as if nothing had ever happened as brown liquid continued to drip from the edge of the seat.  I think someway or another I’d rather be in Russia. 

"You survived the thunderstorm..."

At least that's what my upper level resident said.  I have been an intern for 3 weeks now.  In three weeks I have taken 10 calls, worked an average of 80 hours a week, discharged 23 patients home, sent 3 people to the intensive care unit and one to the cardiac critical care unit, cried once, and learned that I could push myself more than I ever imagined.  It has been a crazy month and an adjustment to say the least.  I have to say the transition was made easier by the fact that I have an awesome team to work with.  My team consists of an upper level resident (who is a 2^nd year), S, and 2 interns, myself and then another prelim intern, N.  We have a great group dynamic and the word “team” couldn’t be truer. 

I bet you are wondering what the “thunderstorm” was…well it was not just starting my intern year.  On my second day I get a page from the nurses to come to one of my patients rooms STAT because he was having a seizure.   I hauled ass to the patients room to find him vomiting, pale as white sheet, and limp.  There were about 5 nurses surrounding him.  They turn to me and say…”what do you want to do about it?”  Holy shit…they want me to decide what to do with this guy who has 101 medical problems and new onset seizure.  I took a deep breath and spat out the first few things that came to mind in that acute moment of stress.  Luckily my upper level wasn’t to far behind me to check my steps and make sure I didn’t miss a beat.  The patient rebounded nicely and the seizure resulted from his heart rate and blood pressure dropping causing him to have a “presyncopal convulsive episode.”  That wasn’t the last I heard from this patient.  He definitely kept me on my toes.  The next day he decides to develop chest pain.  Just great (I say that sarcastically)!! We drew cardiac enzymes on him and they were all POSITIVE…meaning this guy could be having a heart attack.  The patient was emergently transferred to the cardiac unit for immediate cardiac catheterization. 

The 2^nd rainstorm occurred when I walked into a patient’s room during my morning rounds to find him unresponsive.  I tried shaking him vigorously and nothing.  Shit!! His oxygen saturation was 67% (normal is 100%).  He would not answer questions when asked and he wouldn’t even sit up.  We had to call anesthesia to come and intubate the patient right on the floor and then we sent him straight to the intensive care unit.  What a way to start your morning!

Both patients made it through their health crisis and were discharged home safely.  I guess you could say that "I survived the thunderstorm.”

About me

I am a sassy young lady in my twenties.  I have spent most of my life as a student.  From grade-school to high school to college, and then onto medical school.  On July 1st 2011 I entered "the real world" as I started my residency as an intern physician. 
Striking a balance between work and play can be challenging, but I have always prided myself on maintaining a  balance.  I have many hobbies including cooking, entertaining friends, exercising, encouraging other people to exercise, building things with my husband, the big green egg, cleaning, trashy television shows, juicing, packing astronomical lunches for my husband, healthy eating, and now blogging.  Can I do it all?  Residency will be a true test of that. Let the adventure begin!