At the Still Point of the Turning World
Residency is over, NOW what? (While I'm waiting for the answer, I'll get some spinning done....)

Friday, November 21, 2003


Well, that's one week of Night Float down. Here's the Cliff's Notes version of the past five nights:

1. Twenty-plus babies born. We lost track somewhere along the line, to be honest. Many, many more arrived during the day shifts. Some genius figured out that these babies were conceived around Valentine's Day last year. My suggestion is to quit advertising lingerie, chocolate and condoms in February, and start advertising support hose, nostril hair trimmers and adult incontinence pants instead.

2. About fifteen assorted admissions. The respiratory season has begun.

3. Some real hairball cross-cover in the ICU, technically run by the second-year on Night Float but involving me as well. We've had a lot of very, very sick people coming in with overdoses recently, including two people who died after massive Tylenol ODs. The respiratory season has nothing over the pre-holiday suicide season.

4. A "Code Pink" on a sick baby who developed superventricular tachycardia, a really fast heartbeat that doesn't deliver blood effectively to the body's vital organs. This abnormal heart rhythm can, in theory, be converted back to normal by stimulating the dive reflex with ice compresses. This reflex is a mammalian physiologic response to abrupt decreases in body temperature, resulting in slowing of heart rate as part of the body's effort to preserve essential metabolic function. Ice packs didn't work in this baby's case. We had to give him cardiac medications and follow the Pediatric Advanced Life Support (PALS) protocol, which was almost laughable because none of the residents in attendance at this wonderful event has actually taken PALS. The best line of the night was from my fellow R3, who was at the end of her shift but ran to this emergency with me. Once we determined the critical heart rhythm, she said "I've got an algorithm for this in my locker," and off she went to fetch it. Cool as a cucumber.

The baby did fine, btw.

4. A Code Blue this morning as we were winding down. An 80 year old woman arrived by ambulance after telling her family she had abdominal and back pain. She became comatose in the ambulance, got intubated upon arrival in the ER, and sent to the CT scanner once she looked stable. In the CT room, her heart rate slowed down precipitously and the Code was called. We did chest compressions, artificial ventilations and gave cardiac medications on the Adult Cardiac Life Support (ACLS) protocol (which all of us have taken, thankfully). Despite all of this, she never regained a pulse, and her abdomen seemed to get fuller and fuller with all of our efforts. After it was over, we theorized that she had ruptured an aneurysm in the abdominal portion of her aorta and was losing blood into her abdominal cavity while we were attempting to resuscitate her. You can't get a heart started if there's no blood circulating, and you can't give a blood transfusion when the largest artery of the heart has a big hole in it.

(And for any interns reading this, please add this to your ACLS cards: after the patient has died, please cover her up with a blanket before you walk out of the room.)

As of this morning, I'm off for the weekend, but as usual I'm stymied about what to do about my sleeping schedule. I should keep to a night schedule, but the compulsion to seek daylight is irresistible. I think I'll split the difference and take long afternoon/evening naps.