Burnt Out

I just finished working 17 days in a row. It wasn't entirely by choice; I was supposed to have Christmas off and work over New Year's, but when one of my partners quit and left on December 13, that left one person short to cover the hospital during Christmas. That meant 7 doctors for as many as 240 patients. I was supposed to work the night shift over New Year's (which I did not feel ready for), so I volunteered to work over Christmas. That way, with 8 hospitalists, the average census per physician would be 20-25, which was much preferable to 30.

The drawback, of course, was that toward the end of my 17 day stint I felt like I was losing my mind. I was averaging about 5-6 hours of sleep per night, and during the last week I was taking call from 5 to 10 pm every other day. This was a mistake on the scheduler's part; she'd originally put me down for three 5 to 10 pm calls in a row, which is straight-up suicide. There was a time when I worked back-to back 5-10pm calls, and I am never doing that again. Let me tell you, Q2 call is not fun at all, especially when most nights I wasn't physically able to leave the hospital until around midnight. And it was during one of these 5-10pm shifts that I experienced my worst call ever: 10 patients in 5 hours (capped out). Neither my partner or I left the hospital before midnight that day.

Christmas Eve was bad. There were lots of patients anxious to go home before Christmas, and I broke yet another record by discharging 9 people in one day. I couldn't even see all my patients on time because I had to see the imminent discharges first, and by the time I saw them and did all their paperwork, it was already very late. I'd had plans to have Christmas Eve dinner at a family friend's house at 6:00 pm, but I wasn't even able to leave the hospital until 6:30pm (still had 5 pts to see at 5:30pm, but I rounded extra-fast). Fortunately my friends had just started eating when I arrived, and the beef tenderloin, homemade mashed potatoes, red wine mushrooms, pomegranates, and cabernet sauvignon soon made me forget what a horrible day I had.

Christmas Day itself was better; I was still happy and smiling from dinner the night before (it was just the breather I'd needed), and I discharged two patients that were more than ready to go home. But a few bad things happened, too. A woman who had meningitis (I'll have to write a whole post about her in the near future) needed an emergent ventriculostomy for rapidly progressing hydrocephalus (went from AOx4 and talking to fixed pupils in 30 minutes), and another patient developed massive hemoptysis and went into PEA arrest during a bronchoscopy. Needless to say it was the Christmas from hell for the covering pulmonologist (who works every Christmas because he's Jewish); to quote him, this was his fourth massive hemoptysis since he first began practicing in the 1980s, and it put him in a foul mood for the rest of the day. Needless to say the pulmonology director had a lot of apologizing to do for his disgruntled colleague when he returned from vacation today; doctors, nurses, and even patients and their families complained about the other pulmonologist's unprofessional behavior. Thank goodness he's usually at another hospital.

The day after Christmas (today) was another day from hell. I'd barely seen 4 of my 22 patients when they announced "CODE BLUE, ROOM _____" (this hospital never says "Code Blue;" they use another term), and I immediately recognized the room number of one of my patients. He was an 86-year-old man who came to the hospital with a pathologic hip fracture from metastatic prostate cancer, and he'd been doing pretty well post-op. Just yesterday I was telling him that the Christmas cookies his family had brought him looked delicious. As I soon found out, PT had found him pulseless and unresponsive. The poor man had at least 2 shocks and 15 minutes of CPR (plus epi, amio, bicarb, atropine pushed into him), and when we  reached the family, they asked us to keep him alive until they got there. Fortunately after the amio and the 2nd shock we got a "strong pulse" and we were able to transfer him to the ICU. There, his pressures were in the 50s-60s. I wanted to start pressors, but one of the nurses (wisely so) told me to talk to the family first. I met with the family and explained the situation, asking how aggressive they wanted to be. Fortunately they were very  reasonable and his daughter said she didn't want any aggressive life-saving measures to be done. "We just wanted to see him," she said.

To me, the timing could not have been better. I would never want anyone's last memory of their loved one to be of doctors and nurses pounding away at their chests and shocking them to keep them alive. My patient had regained a pulse long enough so that his wife and children were able to see him lying peacefully in bed. They had enough time to summon a chaplain to the bedside, and they were together when the patient was extubated and eventually died. It was a good, peaceful death, which is what I wanted for him.

Of course, the whole case with this patient took up a good hour of my time, so I spent the rest of the day struggling to see the rest of my patients in a timely manner. And honestly, between the death of my patient and the fact that this was my 17th straight day of work, I was in a pretty foul mood. I told my colleagues that I felt like death, could barely keep my head on my shoulders, and was at the point where I simply did not care anymore. I spent 17 days taking care of other people, but never had time to take care of me. I didn't leave work until 6:45 p.m., and I am pooped.

Thank goodness it's over.