Last night’s lessons in the ICU all involved interpersonal interactions…much like previous call night’s lessons. These however, all involved conflict with other hospital staff & physicians…
For starters. I take a trauma patient to MRI with known spinal fractures and in spinal shock, on levaphed & fluids. People start moving and pushing him around until I yelled, “STOP!” People get so used to seeing patients in C-collars with “Log Roll Only” instructions that don’t have real injuries that they forget how to treat the patients that DO have real injuries. If you’re curious, the person at the head should always count…nobody moves the patient until the person at the head gives the command!
OK, Next. The MRI tech is pissed that I use up MRI time waiting for pressure tubing to materialize so that I can monitor my patients continuous arterial blood pressure…you remember, the patient in spinal shock on vasopressors and fluids? I asked her what people usually do in my situation. “They just stop them [drugs] for the MRI.” Let’s see…I didn’t go to four years of evil medical school to have this lady tell me how to take care of a spinal shock patient, even if I am using up valuable MRI time taking care of him properly. As it turns out, after waiting for about 15 minutes for our runner to go to the ICU, get tubing without the right connectors and come back down, suddenly the right tubing materializes in the MRI suite. Hadn’t we just asked them if they had some?
Don’t even get me started about this patients spine surgeon who told the nurse the neck was cleared but didn’t leave a note documenting his visit in the chart. I refused to let the nurse take his cervical collar off without first hand evidence and confirmation of the information she had been given. I called the ortho/spine resident on call who basically blew me off. It was a good thing too, because this morning, on reviewing the MRI, his neck was not OK. Always check labs and imaging studies yourself.
Hmm…so now we’re about to yesterday afternoon at 3pm. I did mention that I was on call overnight, right? So the rest of the afternoon and night went like this until this morning, when the 3 upper levels had to present the whole service to the new interns as well as the attendings. That went over like a ton of bricks for everyone.
Oh so many more morbidly frustrating things I could write about, but you’d probably just get bored with this post and quit reading altogether.
Time for sleep, time for crawling into my post-call world of darkness.