On-call liveblogging: An unusual ICU problem

I'm on call in the intensive care unit tonight. Several of the rooms in the unit are temporarily closed for maintenance reasons, so I've got some time to sit down. In fact, I thought I'd get ahead of the sleep curve by heading over to the call room to lie down for a nap. (After all, who knows what's waiting out there later in the night?) But I have a problem I've never had on call before: I can't sleep. It's hard to even imagine it. Being on call every fourth night there's never a time when I don't feel like sleeping, but here I am, sharing my insomnia with everyone in a blog post.

On-call liveblogging: What's Grandma been up to?

In the hall behind the Emergency Department just passed a pleasant-looking 70s-ish lady wearing a sundress.

Being escorted out of the hospital.

By a police officer.

In handcuffs.

On-call liveblogging: Graffito

In one of the surgical call rooms, on one of the bunk beds, someone has written on the slats under the upper bunk so that the person lying in the lower bunk sees just above their head: "You need to preround."

This may not mean much to someone who's never been on call, but trust me -- it's funny. Sort of.

On-call Liveblogging: Labor & Delivery

Have a rare opportunity here in the middle of the night on L&D to revive my old habit of on-call liveblogging. Many babies delivered in the past weeks, including one the other day to a mom who declined anesthesia and labored to the end full of grace and with a smile on her face; very inspiring.

The new OB interns started yesterday. In fact, one of them moved in with the J-Bomb and myself. Seeing as how we now have a Peds, Emergency, and OB resident living together we should be able to handle any precipitous delivery that comes along in our apartment.

On-call Liveblogging: Final Exam

In my line of work we perform physical exams all day long. Many of them can be quite specialized; for example, the exam of the patient with eye pain differs somewhat from that of the patient with rectal bleeding.

One of these specialized exams is performed when we are called to the bedside to pronounce a patient's death. There are certain exam criteria that must be met before we can officially declare a time of death, and sometimes it can be a slightly eerie experience. There's often no one else in the room. If this was your patient you may have been examining him or her several times a day for weeks. Often you knew the patient's body intimately, and now you're seeing it in an entirely different condition. There can be unsettling impressions: did I just see an eyelid flicker? am I certain that I don't hear the slightest murmur of cardiac activity? Just wishful thinking, unfortunately. (Although death can be a more dynamic process than one might think.)

Here's hoping that I don't need to perform this exam on tonight's call....

On-call Liveblogging: ICU Solfeggio

Things I think about in the ICU at midnight: the alarms on the ventilators sound out the melody "sol do fi sol sol."

On-call Liveblogging: Thanksgiving edition

And here it is, Thanksgiving evening heading into night. Managed to send holiday wishes to only a few friends & family -- apologies for not being better in touch with everyone.

Kind of a crazy day today. A lot of labs and offices were closed or slow, which put some pressure on the clinical side. Not sure how tonight will go, but there'll be some cleanup to do tomorrow.

The hospital gave us meal tickets for turkey in the cafeteria, so I managed to get a Thanksgiving dinner with only the pie interrupted by a page. Rumor has it that there's some pumpkin pie in the resident room, so I'm strongly motivated to head over and, um, write a clinical note. Or something....

The return of On-call Liveblogging

I'm on call this weekend (a so-called "black weekend") and have the resident room all to myself at the moment, so I thought I'd revive an old category of blog posts.

These days it's Neurology: strokes, dizziness, seizures, and extra-big reflex hammers to elicit extra-big reflexes. (If you think I'm exaggerating and you ever have the chance to check out a neurologist in the hospital, eyeball the hammer -- they're big, heavy weights swung around on long handles. Much more effective than the little rubber triangles we're used to seeing.)

Hmmm, I can hear a commotion in the hall, so I'd better sign off for now. More later, perhaps....

Legends of the Call

Why the blogging radio silence you may ask, faithful reader? Well, lemme tell ya....

I've been rotating on Cardiology, certainly a vital area for an emergency medicine doc to know a thing or two about. However, the census of patients more than doubled just before I came on-service, so it's been busy, busy, busy. I'm on q4 call, which means that every fourth day I'm on for 30 hours straight. It's a truism among doctors that call gets a lot harder once you pass 40, and I'm here to testify to the truth of that. Everybody wilts by the end of call, but I'm having a tough time keeping up with my much younger colleagues. Today is my only day off in a 12-day stretch, so I wanted to seize the opportunity for a quick post.

However, I'm off to the library now. Every month we take a standardized test that's compared with scores in other programs around the country and reported to our program director, and today's my only chance to study and take it before the end of the month. Not exactly what I'd prefer to be doing on my day off, but whaddya gonna do? Nobody said that being intern would be easy. Or humane.

Prisoner's dilemma

After a long hiatus, On-call Liveblogging returns! Yes, tonight I'm on call with the Ophthalmology service. But the stakes are high, because tomorrow is the ophthalmology exam. Med school exams are generally no fun, and this one carries a particularly brutish reputation.

Hence, my dilemma. On the one hand, as a budding emergency medicine doc I would relish a night of being called to the ER for burst and bloody eyeballs, horrific pus-dripping ocular infections, and mysterious cringe-inducing presentations of disease in that most squeamish-making of organs, the eye. On the other hand (and if there's one thing I've learned in medical school it's that there's usually another hand), the big test is tomorrow and I really do need to hit the books. As always, failing one of these tests is easy to do and has dire consequences.

Of course, there's actually very little that I can do to influence the outcome. (Powerlessness, thy name is Medical Student.) But deep in my heart of hearts, what do I root for -- the ER or the library?

And in any case, thus far I seem to be opting for choice number three -- blogging.

On-call Liveblogging: Baby, baby, baby...baby!

Whew. Four deliveries last night. Little cuties being passed around, placentas bouncing off the walls. A great day! (Well, night/day/night/morning, really.) Even managed to get a couple of hours of sleep. But we were looking a little ragged on postpartum rounds this morning. We're keeping an eye on the board today--right now nobody's in labor.

At this point I'm about 77 hours into my long march of duty and call, with about 30-some hours left to go. I'm heading up to the nursery now.

On-call Liveblogging: Calm before the parturition storm

We now have four women in labor. I'm hunched over a computer, quickly reading up on particulars relating to each patient. Things are going to get very busy here very soon.

On-call Liveblogging: Pregnant with anticipation

It's Saturday afternoon and we've got three patients in labor. (One of them just asked me if I would be delivering her baby!) If I'm going to catch any babies, it'll probably be soon. Of course, they'll all probably go at the same time....

On-call Liveblogging: Seen and heard

Overheard at the L&D nurses station:

Nurse A mentions that she doesn't like spicy food. Nurse M is passing by, and he says "liar, I know that you like hot things." Nurse A replies, with a sweet smile and without missing a beat, "No I don't--that's why I like you."

Strong work, Nurse A.

On-call Liveblogging: Waitin' on my baby

This post is comin' at ya live from OB call. I've been on-call or on duty since yesterday (Thursday) morning, and I'm on straight through until end-of-day Monday. My mission? To deliver a baby. I did a few on my OB/Gyn rotation last winter, but I've been hoping to get some deliveries here in Sioux City. Unfortunately, I'm having no luck at all. As soon as I walk onto the Labor & Delivery floor, everyone's contractions stop. A couple of days ago I got within about 90 seconds--I was gowned and gloved and getting into position, when baby's heart tones crashed and the attending ran into the room, ordering emergency equipment. Both mom and baby did fine, but it wasn't a delivery for a med student.

So wish me luck and think fecund thoughts on my behalf.

On-Call Liveblogging

Tonight I'm on call with three services--Family Practice, OB, and Pediatrics--and things are very quiet. Just a minute ago I grabbed some dinner, observing the two cardinal rules of eating while on call:

1) You're allowed to eat anything you want; diets don't count, as long as

2) whatever you eat is portable and easily gobbled, since the probability of your pager going off is proportional to how much you're enjoying your calorie-laden treat (see Rule #1).

My choice tonight? A cheeseburger from the hospital cafeteria. And I got to eat the whole thing. Mmmm....