This week has been full. Very full.
I was at clinic till 11pm finishing up the massive pile of charts that accumulated from before my village trip to Little Diomede.
Tuesday was a simple clinic day and a breath of air, before wednesday.
Then came the full moon day. I like to think I’m not superstitious, but then I do believe that the full moon means it’s probably gonna be a crazy busy shift.
Today I was back up call for the resident (who is doing an amazing combined Family medicine-Emergency Medicine training program). And still a little part of me is surprised~”What?! I’m an attending now?!” 🙂
We worked together in the ER in the morning, then I saw patients in clinic in the afternoon.
During a busy clinic, my nurse knocked on the exam room door, and said, “They need you in the ER stat.” Ok, I left my patient and ran to the ER. I walked into the trauma bay where a nurse was doing CPR on a non-responsive man. Ack! Help! We started coding him, had to shock him several times. We intubated him and gave him all the resuscitation drugs we have, including multiple doses of Epinephrine, then Amiodarone, then even Lidocaine. His heart started in Torsades and we gave him Magnesium. Then Calcium gluconate and Bicarbonate. We shocked him several times. His heart came back to beating in an organized rhythm with a pulse, and he was even breathing, but then his heart quickly returned back to fibrillating with no pulse. He maintained his blood pressure for the most part and he had good O2 saturation. The resident tried to start a femoral central line, but it kept failing. Unfortunately I have never done a femoral central line. Where I trained, we always surgeons who did them. There are no surgeons here now.
But because of that, we coded him for an hour. And besides these flickers of hope, there was no real response from the patient. I called for help to the critical care docs in Anchorage and explained the situation. They both said that I needed to stop the code, because a code that lasts longer than 30 minutes is pretty much never successful. I explained that he had given us hope a few times during the code, so we kept going. I told them that I wanted to make sure I didn’t miss anything, or shouldn’t be doing or thinking of anything else. I added that I’m still fairly new out of residency, and I’m more used to having a critical care doctor by my side during a code that would help think of everything (when my brain is frantic trying to make sure we run the code and trying to think of every possible reason and diagnostic test that needs to be ordered). One of the doctors reassured me that we had done everything, and said, “We have all been there–it’s hard and scary. Here’s my cell phone number in case you need to call.” It was so nice to have his reassurance. But I really miss the days when we had a designated code team that responded to codes that included a critical care doctor, ICU nurses, Surgery, Anesthesiologists, Respiratory Therapy, Pharmacy, Lab, X-ray, and ancillary staff. But this is where I learn the most, and that’s ultimately what I want–to be pushed out of my comfort zone.
Then after finishing up the code, I went upstairs and checked in on a pregnant lady who was very preterm, and her water had broken, and she was having contractions. The last thing we want to do in Nome is deliver a 32 week baby, who will likely need a NICU.
So we called for the neonatal resuscitation team to come up to Nome. they told us they had 3 flights to pick up other patients in Alaska, and that it had been a crazy day! So we decided to take the OB down and we could do neonatal resuscitation if we needed to. In spite of medicines to stop the contractions (tocolytics) the patient was contracting the whole way to Anchorage. I was sure we were going to have a baby in the airplane, since her cervix had been dilating before we left. Luckily she didn’t.
When we got to Anchorage, there were patients out in the hall. All the docs there looked frazzled as well. The OB doctors told me there were 3 of them on, and usually there’s one or two.
It wasn’t till we were leaving Anchorage late, that I noticed it was a full moon rising…that explains the day! 🙂
Got home at 3am, got a few hours of sleep and went back to clinic.
Thursday: I was tired from lack of sleep, but just had a day of clinic.
Friday: on call again! Saw quite a few ED patients, fielded several village emergency patients, had a total of five admitted patients. Two were very complicated Internal Medicine/Neurology cases. Got home late–my brain was fried!
Saturday: Rounded on my patients, discharged two! spent a few hours at the hospital. But tried to relish my last day off in the last three weeks of May!