The Adventures of Medical Internship

NIGHT FLOAT

So for the past two weeks, I’ve been working thirteen-hour night shifts at the hospital (7PM-8AM). I’ve worked the night shift before (granted, it was 11PM-7AM) so it didn’t take me long to adjust to being nocturnal. I’m not saying it was fun, however, since my eating schedule was all of out of wack and I ended up losing five pounds. Sleeping during the day wasn’t really an issue for me, but the complete lack of social contact (except for everyone at the hospital, of course) was kind of depressing. I hardly saw the hubs and my pets and it really started to wear me down. I never had any time for anything else but eating, sleeping, and working, so I’m glad it’s finally over. I had Saturday nights off and I pretty much spent them eating, sleeping, and watching Supernatural, since I had no motivation for anything else. I don’t know how people do this forever.

Anywho, I had a few adventures worth talking about. Hopefully they’re as interesting to you as they were to me!

I pronounce you…dead.

I was called to pronounce a woman dead on my very first night. A nurse phoned me and said, “Hi doc, Ms. Such and Such has passed away.” I sat there for a minute and all I could come up with was a dumbfounded, “Huh?” and she laughed and said, “Can you pronounce her?” and I was like “OH! Okay then, be right there.”

I had never pronounced a person dead before but I’d seen it done. I walked over to the nurse’s station in the hospice unit and they were like “Heeeeey, new intern! Let us help you!” And they did, tremendously. I filled out the appropriate paperwork before I entered the room, finding Ms. Such and Such’s (let’s call her Ms. S) three bleary-eyed daughters at the bedside. Apparently, she’d already been dead for an hour. I introduced myself and expressed how sorry I was for their loss. Ms. S had metatastic lung cancer and died peacefully in her hospital bed. I asked her daughters if they wanted to step out, but they wanted to watch me pronounce her. So I did.

Of course, having an audience made me a little nervous. When I pronounce a person dead, I usually start with the benign things, like listening to her heart, lungs, observing to see if her chest rises and falls, checking her carotid and radial pulses. Then I move onto the neurological exam—check if her pupils respond to light, rub a piece of gauze against her eyes to see if she blinks, open her eyes and turn her head to see whether she tracks me or not, pinch her fingernail really hard to see if she responds to pain. Technically, we’re supposed to try to make her gag, but I spared her daughters of that. Once I was through, I pronounced her dead at such and such a time, expressed my condolences to her family again, then I was off.

I’m sure I’ll be doing this plenty more times throughout the year.

Bleeding out of orifices you never want to bleed out of.

Also on my first night, a woman had been admitted for a GI bleed (colonic) and the bleeding vessel decided to rupture at 2AM. Let’s just say that when I walked into her room the scene wasn’t the least bit pretty—there was blood EVERYWHERE. Her vitals were stable but I decided to transfuse her and ship her to the ICU since the bleeding wouldn’t stop. She ended up having the vessel embolized (or sealed off) by interventional radiology (hell yeah, radiology!). Yay for saving lives and all that. 🙂

Electrical Malfunction

There’s something about nightfall that makes everyone’s heart go into abnormal rhythms. I swear I saw EVERY type of arrhythmia during the night shift. The first one I had to deal with was a supraventricular tachycardia (or SVT), where the heart rate can get upwards of 200 beats per minute and the person can feel their heart trying to slam its way out of their chest. They get dizzy, nauseous, and they feel like they’re going to die. The problem is that they can, ‘cause when your heart is beating fast enough it doesn’t have time to fill up with blood and you can easily lose perfusion to your organs (especially your brain). So you can imagine when I received my first call about this, I had to check my own damn pulse, lol. I ran up there, found this fairly young woman in total panic, but her blood pressure was good. So I hit her with adenosine, a drug that literally resets your heart rhythm by stopping the electrical conduction momentarily. It usually works like a charm, but the problem is the patient can feel it too. And if this lady thought she was dying before, imagine how she felt when her heart stilled in her chest for a full three seconds. I talked her through it, held her hand and told her to keep looking at me. I asked her to tell me about her family, trying to distract her as it was happening. She did just fine and her heart rate dropped back down into the 80s. I put her on a Cardizem (a conduction stabilizer) drip to keep it from happening again until Cardiology saw her in the morning.

Whew! I was a pro after that. 😛

CODE BLUE: Cardiac Arrest

About midway through my rotation, another intern, Siv, and I were sitting in the cafeteria at 7AM having breakfast. It was nearing the end of my shift and I was getting ready to sign out to the day team. On night float, we carry around three pagers—your own pager, the code pager, and the night coverage pager. Usually the night coverage pager is the one that goes off every five minutes during my shift. So as I was devouring my egg and cheese sandwich, my code pager erupted and I nearly spewed out my food. The text page read: “CARDIAC ARREST IN THE ICU”. Siv and I exchanged horrified glances and we bolted out of our seats and headed for the stairs. The ICU is on the top floor, so we had to hurl ourselves up four flights before we burst into the ICU. A few members of the ICU team had already arrived, and one of their seniors had taken charge, so Siv and I jumped in and started doing compressions on the guy.

As I was slamming on this elderly guy’s chest for two straight minutes (can I express how absolutely exhausting that is?), I finally took a good look at him. He was intubated (meaning he had a breathing tube down his throat) and there was black fluid coming out of his mouth. Blood was spilling from between his legs as the nurse kept her hand on his femoral pulse, and I’m like “What the hell happened to this guy?!”. Apparently, he’d arrested at home and fell into a glass table; one of the shards sliced his femoral vessels open (not sure which, likely the vein or else he would’ve bled to death before he even reached the hospital). Talk about bad luck! The paramedics revived him in the field then he coded again when they arrived in the ER. They revived him again, then he went to straight to the OR to repair the laceration. As soon as he arrived in the ICU, he coded again, and that’s why we were there.

We slammed him with adrenaline (and several other drugs I’ll spare you from) to try to get his heart pumping on its own. He didn’t have a pulse so we couldn’t shock his heart into a normal rhythm. We didn’t stop for a full 35 minutes, me and Siv alternating compressions, feeling his ribs crack beneath our hands. It was absolutely awful. No matter what we did, no matter how hard we tried, the third time definitely wasn’t the charm. His family showed up during the last five minutes, and they burst into tears, collapsing onto the floor and crying in anguish. The trauma surgeon finally ordered us to cease, knowing that even if we managed to revive him, he would be utterly braindead. I left the hospital feeling sick and numb and couldn’t sleep for a long time afterwards.

I knew I’d experience this sooner or later, but no matter how much you prepare for it, it still hits you pretty hard. I’m hoping the next one will have a happier ending, but unfortunately, those tend to be rare.

So all in all, it’s been a pretty crazy past few weeks! Forgive me if I haven’t been very active. I hope everyone’s well and I’ll try to catch up with you all over the week. I’m on radiology elective for the next two weeks (and I have the next two weekends off!) so the break is well needed. And besides, it’s RADIOLOGY. How can I not love that? 😀

Until next time…