Becoming a Vampire

Well, after some time on the wards, which turned out to be a great two weeks learning experience, I have now changed my rotation to nightfloat. I essentially work 8:30 PM-7:30 AM for the next two weeks. My job is to cross cover (ie: take care of all the inpatient teams) and keep the patients alive until the primary team gets back in the morning.

My first night was from hell. The pager did not stop going off until about 3 am. And even after that, I barely had time to sit down and think. That was offset by last night which was much smoother. I had plenty of time to do the work I needed to do, respond to intermittent pages, and even do a little reading! Yes, reading up on disease management etc. is NOT an easy thing for an intern to fit into the schedule. One must be SUPER efficient to actually be able to get some reading done, or have a nice, calm, night. That being said, I hope I didn't just jinx myself.

So in contrast to my last post, where I was having difficulty deciding on whether a plan of action was just too much for a patient, I had an interesting experience from the opposite perspective the other night. One of my patients actually was going downhill, and FAST. We were running out of options on the floor, and decided the patient probably needed to be transferred to the ICU for further managment. At this point, we had to think about what was our best plan of action. This patient was 90+ years old, but the family wanted FULL CODE status. The patient also had severe dementia making it difficult for us to establish was a baseline mental status was, although according to the daughter and the nurse, by the time I saw the patient at his/her worst, he/she was apparently well below baseline. My resident and I both felt that an ICU transfer should be done since the patient was full code, but the odds were not in the patient's favor of survival. On the other hand, the family insisted we do "everything we can" to save the patient's life. I can't pass any judgement on issues such as these for a few reasons. First, I have never been a family member in this particular situation so I wouldn't know how I'd react myself. Second, I don't have enough experience as a physician to compare to other situations where another patient's status was similar, and an outcome had already been established. That being said, I felt that this patient probably would be best managed without invasive treatment, do everything we can minus full code, and provide comfort care if it came down to that. This is opposite to what the family wanted. So of course, without any other advanced directive, this patient had to be transferred to the unit and most likely required intubation and a host of other invasive treatment modalities.

That was just one piece of my first night as a night float. On top of that, this occured 10 minutes BEFORE my shift should have ended, which means I ended up staying at the hospital much later than I anticipated. I hope all turned out well for the patient and the family, but I'm not quite sure what happened.

On a happier note, I did get to go to the Charles River to watch the fireworks display last week! It was beautiful. Even despite the rain, and the cold weather, we managed to have a good time and enjoy the company around and the show. Boston truly has some spectacular scenery. I also got to spend some time out by the pool on Sunday on my day off. That was nice. During the end of my last year of medical school, I managed to spend many hours by the pool, or on the beach in the carribean, and 3 weeks of work in the hospital under flourescent lights has already managed to rid me of my tan and make me look like a ghost, or better yet, a vampire since I'm now awake all night- and sleep during the day (but I promise I do NOT sleep in a coffin!!!)