Call

I have managed to survive my second night of call as an intern. Let me explain. I am on a rotation in the CCU--the Cardiac Care Unit. The patients we admit either have a previous diagnosis of heart disease, or they are being admitted to our service because they have experienced "chest pain" and need to be "ruled out" for having a heart attack or MI (myocardial infarction--fancy way of saying heart muscle injury). Monday, Aug. 1st, was my first day in the CCU, we change rotations on the first day of each month. I was on call. My first night of call as an intern. Call means that we show up to the hospital at 6 a.m. one day, see our current patients, and admit any new patients to to the cardiology service to our team. We do that all day and all night until 7 a.m. the next morning. Then we round with our attending (see previous post for hierarchy of doctors) and go home (hopefully) by noon, 18 hours after we entered the hospital. We go home, sleep and show up at 6 a.m. and start all over. Call is q4, meaning that every 4th night this month I will spend the night (not that I get to sleep there, mind you) in hospital admitting new cardiology patients and taking care of small issues with our current patients.
Call #1: Aug 1st. Starting a new rotation was ALWAYS unnerving as a medical student. Your grade depended on how well you performed and how well the attending and residents liked you. As an intern...It's worse. You show up at 6 a.m. and have 4-8 patients that assume in 5 minutes you will know their entire medical history, what brought them to the hospital, and how best to take care of them and send them home...All before the first (of many) bottles of diet coke has had time to settle in your stomach. And to top it all off, Day #1, I'm on call and carrying the CODE PAGER!! That's right, if someone in the hospital codes (their heart stops beating or they stop breathing on their own, or both) and a code blue is called, the code pager (I'm carrying one of many such pagers) goes off and alerts me (and a whole bunch of other epople) to the patients room number, where it is expected that I will show up in a matter of seconds and begin resuscitation efforts on that patient.

In case there's any doubt in your mind, this is one of the scariest things about being an intern. We all have to take ACLS (Advanced Cardiac Life Support) and learn how to "run a code," but until you show up and see one in progress and have someone asking you (me) what drugs to give to get this person's heart beating again...You have no idea what to expect.

So, of course, at 2 a.m. my first night in the CCU, my first night of call, the code pager goes off. Thankfully, I was not the first doctor there and therefore did not have to make any decisions. I would like to tell you that I put on my Superman cape, ran into the room, and in a moment of brilliance saved a person's life. It didn't happen that way. This patient was being well attended to by the time I got to the room, but I might as well have been 3 years old...I had no idea what to say or do. I don't know if I've ever been more intimidated in my whole life. I never went to a code as a student and like anything you do for the first time, you don't know what's expected or what to do or how to handle the situation until you've been there. [This is the main reason people without children (myself included) are so STUPID (again, me included) when they start talking about how they could raise someone else's child better, or how they would NEVER let their child do this or that] (This attitude has probably ensured AT LEAST 2 or 3 temper tantrums in Wal-Mart or a museum from children that I hope to have someday...Sorry Mom and Laura, that's not today, or even this month, really, not even this year. The next code I go to, I will be a bit more prepared for and hopefully will handle the pressure better.

Call #2: As I type this, I am post-call. I went to the hospital yesterday at 6 a.m. and got home around 12:30 this afternoon. I would like to say that in a city of 4 million people, no one got sick, no one had chest pains, and that no one came to the hospital. ALAS! None of that happened! Was it a full moon last night? I went to the ER about 3:00 a.m. and it looked liked a rock concert gone bad. There were people EVERYWHERE! Thanks to the same ER last night, and the nurses of 3 Cullen (the main floor where the cardiac patients go) I got a grand total of 30 minutes of sleep last night, and fortunately, not all 30 minutes were at one time (insert sarcastic voice here).

There's so much more I could tell you about last night, but let's face it, I've had little sleep and rambled on enough, even for me. Regardless about what (or how) you read the above...I'm loving it! I am doing what I've been waiting my whole life to do. I have MUCH to learn, but man, this is good stuff.

p.s--As I went back and read the above verbage, I realized how vulnerable saying these things can make me. It's hard to admit your failures or weaknesses and there are some who would say that they would have handled the code much better than me. And they would be correct. But they've been there and done that before. My friend, Keith, from medical school, who is currently in Iraq serving his country, was a paramedic before medical school. He ran TONS of codes on the back of an ambulance. As a 3rd year student, Keith happened to be outside a patient's room as they coded. Keith stepped in (as a 3rd year STUDENT, mind you) and began to run the code in spite of his attending and others there who were "??more qualified??" than he was to run the code. I was not there, but the story goes that someone asked Keith's attending (as Keith was performing CPR and yelling at nurses to push drugs) if he was capable of "running a code". The attending very matter-of-factly said, "Yes. And probably better than you or me." I will be in a code situation again, and by the time I finish my intern year I may not be a good as Keith (this guy is amazing) but I will be better at handling codes.