It’s one thing to try and coast your way through your last ten shifts. But when nurses grab you and say, “He’s not breathing so well,” you still need to jump into action. This guy was circling the drain when he came in , unable to talk, gasping for air. he only said one word to me. I asked him if he wanted us to put a breathing tube in and he said “NO.” He never said another word to us after that. I confirmed his wishes with his family, so then it was settled. No CPR, no Inutbation. That made my job easier in some ways, but harder in others. Intubating someone is a pretty definitive treatment for lots of things, but when you can’t intubate, you need to be a little creative. we put a positive pressure mask on his face, gave him diuretics, morphine, nitriglycerin. I had to get labs from his femoral vein which must have been as big as a garden hose because I had absolutely no trouble hitting it with one stick. I even considered doing a therapeutic paracentesis to allow better diaphragmatic excursion, but a quick ultrasound showed that his big belly was all liver.
That patient consumed hours of my time, which would have been fine, except that I had ANOTHER patient with fever > 40 degrees (what’s that in F?), headache, neck stiffness. Uh oh. He was sitting out in triage, dressed. He needed STAT antibiotics for presumptive treatment of meningitis, he needed respiratory isolation, he needed a spinal tap, but the ER was FULL, many of the beds occupied by admitted patients who had no beds in the hospital.
It was just the beginnin of a long night. The chart anxiety I develoepd by the end of the night was alleviated by a fresh set of residents coming in at 10 & 11pm. Whew. I admitted my first four patients of the night, sent home about another four, had an easy psych admission. I really didn’t see all that many, but my time was consumed by those two sick ones. It’s been awhile since I was that busy!