MICU: Overnight Call

The last week of MICU went pretty smoothly. I got to be pretty good at transferring patients out of the unit. Two of my patients who had been in the unit since July finally got well enough to transfer to the PCU (much to the dismay of the PCU intern, who said that every other transfer note coming to the PCU was written by me) One of my calls was hectic b/c a nurse kept pestering me about a patient's BP being 220/104 (she was asymptomatic), and when I called the fellow, his response was to ask me whether I knew the difference between hypertensive emergency and hypertensive urgency. Ohh. *sigh* Good thing I called while he was eating dinner and not in the wee hours of the morning; he must have thought I was dumb.

As "luck" would have it, my very last shift of MICU fell on a Sunday, and I was overnight until Monday morning. It was just me, the overnight PGY3, and the pulm/crit care fellow for the afternoon and a good part of the evening. One of my patients developed a bad leak in her trach (which, after what happened with the patient in my last entry, had us very worried), and after way too many tidal volume readings of 50-200 ccs, we had anesthesia come to reintubate her (but not before she got bronched and had a huge mucus plug that had been blocking her left carina sucked out; that was part of the reason why her tidal volumes sucked). No one wanted to take the chance that her trach would last until morning. My PGY3 wasn't around while all this was happening, and later the fellow asked me if this sort of absence was normal. I told the fellow that my PGY3 was easily reachable by phone if I ever needed him, but silently thought, "Yes, this is normal." We had a patient close to death after her family withdrew care, and when I asked him if he wanted to be notified of her passing, he said no. "You know what to do, right?" he said. Yes, I did (he made sure to teach me when we had our first death), so I pronounced her, filled out the packet, and called the fellow when it happened. Don't get me wrong, I liked having independence in the unit, but I thought the PGY3 could have shown a bit more interest in the patients. He never even asked about her until the next morning.

Another of my patients, SS, had continual bleeding from her permacath site (oozing). Not wanting to bother Zael, I ordered thrombin spray and gave her platelets, blood, and FFP. Nothing truly worked, not even after I applied pressure for 15-20 minutes. When my resident showed up in the morning and I told him what happened, he asked if I gave her DDAVP. -__- Nope. He asked me why I didn't call the PGY3 for help or advice. It hadn't occurred to me b/c I'd asked one of the overnight triage residents for help, and she'd never mentioned DDAVP to me. *sigh* That was negligence on my part; I guess I should be lucky she didn't bleed to death or else I'd really be in trouble. I felt bad for letting my resident down; just last Friday, when I asked him how I did on my rotation overall, his only critique was that I had to know when to ask for help so that I won't get overwhelmed on the job. And what happened? I didn't ask the PGY3 for help about my bleeding patient because I didn't want to wake him up. *sigh*

Now I'm starting ambulatory, which involves spending half-days at different departments and specialties (ENT, rheum, cardio, nephrology, to name just a few) to get an idea of what outpatient medicine is like. I'll have weekends off, hours are 7:30-5:00 pm. No complaints =)