ICU: When the young are ill

We changed upper level residents today: Aaron and Eddy left, and we gained third-year Kindrick and second years Tony and Sarah (whom I worked with during my IM rotation). When Kindrick saw me and Garrett, he asked if any of us were on call today. "I wasn't planning on it," I said, and he said, "Why, because you knew I'd be on call tonight?" Nope. So now our team is a ridiculously large size of eight (one chief, three second years, two interns, and two med students), and we only have nine patients. And guess who's seeing two patients? Me. I haven't had much interaction with Tony so far, but Sarah's been great as usual. This afternoon she let Garrett do an LP on a septic lady with enlarged ventricles. It took several sticks and pokes (at least 4-5), but then Sarah said, "I'm going to try one of these old holes." (the lady had a previous LP attempt yesterday that had failed to turn up any CSF). There was silence, then Garrett said, "Oh, oh! There it is!" Finally, we struck gold, and when we measured her CSF (it was clear), the opening pressure was 25 (normal <18). Damn. But we're testing her for everything from herpes zoster to West Nile virus, so hopefully we'll get a diagnosis.

We got a new attending today, Dr. P, a pulmonologist. Kindrick introduced himself as "one of the Indians," which fortunately Anita explained to me back in obgyn as meaning, "one of the chiefs." Dr. P didn't even listen to my entire presentation (unlike Dr. C, who lets us run down the entire list); he'd interrupt to ask why my comatose patient was on four different seizure medications, or why my Ludwig angina lady wasn't on vancomycin, among other things. *sigh* This one is hard to please. We finished rounding with about an hour to spare, so Garrett and I passed the time by talking about our musical backgrounds and where to get decent Chinese food in the DFW area. There was no lunch b/c there was a residents' meeting, so Garrett and I went out to Paul's Donuts, a restaurant that sells pretty good gyros (of all things; the name is pretty misleading).

Loan and Sarah asked Garrett and me if we were taking call this week and seemed disappointed in us when we said no. I know Garrett never wants to take call again b/c nothing ever happens when he's on call, so instead, I offered to do a short call today (no overnight). Sarah said that sounded fair enough. Garrett left after doing the LP, and when Kindrick said I could leave too, asked if anything was going on. "Not right now, and I don't want anything to happen right now," he said, and said something about the ICU "ju-ju" (whatever the hell that means) when one of the nurses ran into the hall and yelled, "Kindrick, NOW!" Kindrick muttered, "Oh shit" and we ran to another patient's room where he'd suddenly gone into asystole. When the nurse shook him, he immediately woke up and his heart started beating again. "What?" he asked, and we all breathed a sigh of relief. The nurse later told Dr. C that she'd made Kindrick wet his pants, and Kindrick said, "It was her fault!" and pointed to me. "You jinxed it by asking if anything was going on!" Haha.

We got one new admit in the afternoon. From the past progress notes and reports online, I read "dilated cardiomyopathy" and thought my patient was a middle-aged woman. Never did I expect that our patient was in fact a twenty-year-old girl. She'd been born with a bad heart and had a tendency to form blood clots (she'd had DVTs in the past and was on coumadin), and her chief complaint was a 3-day history of abd pain and nausea & vomiting. She also complained of numbness and swelling in her right leg, and her angiogram showed two clots, one in each femoral artery. Surgery fixed her up by dissolving her clots (go TPA) and putting a catheter of some sort in her femoral arteries to prevent future ones, and she was sent to the ICU. When we saw her, she was in very bad shape. She had a fever of about 100, she was diaphoretic, and despite an O2 sat of 100% her lips looked purple. On top of that she had no pedal pulses. Her EKG looked horrible. There were suggestions of infarcts and at one point her heart rate shot up to the 220s, while her BP kept dropping. Her prognosis looked so ominous that a crash cart was parked right outside her room, and family was brought back to see her. Then we learned that her mother had died five days ago from complications after surgery, and they had just buried her today. To make things worse, Dr. C was at his son's soccer game and nowhere nearby, and the cardiologist never once showed his face, and that pissed everyone off. "She's only 20!" said one nurse. As though we could forget. And to make matters worse, her BP dropped to 53/30.

I felt bad for Kindrick, getting swamped like this on his first night on call in the ICU as a chief. Later he got a page from some drug reps who'd brought dinner for the family residents, and he told me to grab some dinner. I let the drug reps into the lounge (they'd brought Jason's Deli) and joined interns Jared and Di for dinner before packing a plate with fruit and sandwiches for Kindrick. By the time I got back to the ICU, things were much better. Quadruple strength Levophed had boosted her BP to 100/70, she never needed to get intubated, and she was awake and smiling at her family. Thank goodness she had youth in her favor. By this time it was nearly 8:00 pm, and Kindrick told me to go home. He was grateful for my bringing him dinner and said, "I owe you one." Me: "No, you don't."

I hope that when I come back to work tomorrow morning, that girl will still be alive.