Saturday, October 23, 2010

The day to day

I've come to the realization that while I'm frustrated by the hospital and I often don't know what I'm supposed to be doing, at least my work keeps my mind off the fact that I would rather be somewhere else. I've had a few work days in a row where I had plenty of things to do to keep busy and for that I am very thankful.

I came in to rounds the other day and noticed that everyone was in the middle of coding a young woman who came in with a 37 week fetal demise the night before and was being induced. They had been coding her for about 45 minutes at that point and no one had bothered to call despite the fact that I was ON-CALL. Umm, seriously interns, this is when YOU CALL SOMEONE!!! Whatever. At least the right people had managed to show up accidentally, from the anesthesiologist (who was just walking by) to the ICU doc (see below) to me (see above) and then the OB attending (that I called after I showed up.) Apparently, one of the interns went up to the ICU asking for amiodarone, which triggered Dr. Beth to politely inquire what exactly she needed it for.... these interns are out of control!! Anyway, I've never actually seen an amniotic fluid embolism before but given that she had an IUFD, witnessed sudden arrest,  followed by seizures and pulmonary edema, it's her most likely diagnosis. She is still up in the ICU intubated and not waking up despite her sedation being held. It's incredibly sad but also slightly miraculous that she is even still alive at all.

Later that day, I was up in the ICU checking on the above patient and noticed poor Dr. Beth bagging the 2 month old ex-28 weeker with the pulse-ox machine registering 40%. I stepped into the heated room to ask if she needed help and by the look in her eyes, I could tell I wasn't the only person feeling completely overwhelmed and outside of their expertise. Dr. Beth is internal med/critical care and she is acutely aware that kids are not just small-sized adults, especially this one. I swung into action knowing that two people with no clue of what to do were better than just one. We were about to stick in a 23 gauge needle with stop-cock into this kid's left chest to relieve a presumed pneumothorax (he already had a right sided chest tube) when we noticed that the ET tube had slipped-- we pulled it back and suddenly he had bilateral breath sounds again. Well, that was easy. Didn't help his lack of pupillary response or corneal reflex though. The crazy thing, though, is that this is the 5th time this little guy had coded and the next day he is always awake and looking around. He goes from living to dead to living again-- so when is enough, enough? As if it weren't hard enough of a thing to decide, this kid defies logic. Nurses call him a gift from God who was meant to live. And maybe he is. I just can't help wondering what his brain function is going to be like after such repeated anoxic insults.

I came home that day and found a woman lying on my grass in front of my house with her approx 18 month old little boy running around my yard. My first thought upon seeing her??? Great, she looks heavy, how am I going to carry her all the way up to the ED by myself to code HER as well? Turns out she was just tired and decided to take a nap in front of my house-- which she continued to do for the next hour or so as her toddler ran around free in the yard and then my kitchen when I opened the door to keep a better eye on him. Because honestly, I don't need a perfectly healthy toddler's accidental death by falling off a cliff or being attacked by baboons on my conscious as well....

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