Sick, sick patients

Last night’s call was busy, but not as hectic as many others. We had four new admissions, and Dr. Grettle finally did the last admission by himself since it was 5 AM and I was rounding on my other patients. The first sick patient to arrive was a very unfortunate forty-something alcoholic with a 3 week hospital stay complicated by cerebral hemmorages (bleeding into his brain), bacterial endocarditis (an infected heart valve), an aortic valve replacement (open heart surgery), siezures, development of left sided hemiplegia (paralysis), sternal would infection (pus coming from the site of his open heart surgury), encephalitis (a detached, semi-comatose state), and persistent daily fevers. Dr. Grettle had me go through his daily MARs (medication administration records) and graph out all the antibiotics he had received in his hospital stay, correlated with the positive cultures he had grown and a graph of his daily maximum temperatures. The whole admission took us 6 hours! By far the best part was putting in a new central line. Based on my previous interactions with Dr. Grettle, I was sure he hated me. As we prepped the patient for the line, the PA and my upper level told Dr. Grettle that I was ‘great’ at my lines (thereby cursing me!). As I inserted the finder needle and proceded to slide it underneath his clavicle, Dr. Grettle started to make a comment about using different landmarks than I was. He was hovering just on the other side of the patient, but not close enough to contaminate my sterile field. Just then, I struck gold! I got a great blood return, and Dr. Grettle left the room. I guess he was satisfied that we would get the line in the right place. The rest of the line was uneventful, and I was on cloud 9. What a great feeling–one stick! It took me at least an hour to settle down and get to sleep afterwards.

A quick 2 hour nap and I was back in the unit helping admit another patient. During my brief siesta, my upper level and the PA admitted another lady, intubated her, put in a central line and a chest tube. Sorry I missed out on that fun. My new patient was an octagenarian vet who had a ‘frozen pelvis’ from receiveing radiation for prostate cancer. His intestines were completely blocked up to the point where they exploded inside of his abdomen. OK, not quite that dramatic, but he did have a small hole repaired and a colostomy placed. He was still hypotensive when I left this mornign after I had given him 2 liters of saline and 500 cc of hespan in a 2 hour time period.

The last patient, Dr. Grettle admitted by himself down in the CCU, which was really very nice of him to do.

By the time I was ready to leave, I was so tired I could hardly think. I took a long, fitful nap on the sofa until about 7:30 pm, then went for a walk before dark. Q2 call is tiring. Tomorrow I am precall, and supposed to leave by 3pm. I only have 4 calls left this month…Yahoo!

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