On Call...

"This is the reason why your headache didn't go away: That's actually pronounced an-algesic, not anal-gesic. Sir, the pills go in your mouth"
~ Turk, Scrubs

I'm fresh out of another night on call, one in which I managed almost 5 straight hours of sleep. It's pretty much unheard of. In fact, I woke up at 4:30am and checked my bleep just to be sure it was still on. Now, that doesn't mean that it was a nice call. It was just a call that involved "sleep." I may have mentioned this before, but I never actually sleep while I'm on call. I'm a light sleeper and the res is never silent. Plus, I hear ever other bleep go off, and the sound of an ambulance backing up sounds shockingly similar to my bleep. As painful as it is to not actually sleep, I'd rather that be my problem than being too sound a sleeper and not hearing the pages (esp with the arrest bleep, or "bomb" as Ben likes to call it, sitting next to my normal pager).

Maybe I was due a gentler call after the last night I had... I don't know. But I've decided that as I'm well past the halfway mark of intern year, I'm going to try to take a learning point or two away from each call I do. Lesson from Friday night: Lots of people want to be leaders, few people actually are.

The arrest bleep went off and I ran to casualty. Some people say that the interns aren't required at the A&E resus, but when that pager goes off, I'd rather be an extra hand than leave them short-handed. We have 3 designated resus beds, and there's no saying that there isn't another in process at the time. On this occasion, there was an ambulance 5 minutes out with ongoing CPR/arrest. One would think the extra time to plan would help... It didn't. I then participated in a 20-minute resuscitation attempt on a person who was, and I know this sounds cold but it's 100% honest, DOA. Why?

Why did we spend 20 minutes (and I'm not going to consider the cost of equipment and drugs) of time on this? That's the lesson. 3 people sort-of, kind-of, maybe tried to run the resus. The person most qualified had stepped back with the feeling of too many cooks in the kitchen. The next most qualified didn't take command of the situation, allowing a lesser qualified person to change the plan from something that was pragmatic and, well, sound to straight algorithm. And the 3rd person that sort-of tried to steer the ship had no clue what the defib was saying, authoritative without the knowledge. I was twice mistaken for someone I wasn't. I had to tell people that 1) No, I am not the anesthetist and 2) No, I am not the medical reg. Now, I do have to say that no one panicked, no one did anything stupid or harmful. We just spent too much time on a no-win situation.

I want to reassure people of a few things. First, under different circumstances (ie: the patient were younger, fitter, hadn't collapsed at home, hadn't been under 10min CPR by the family, hadn't had 40min CPR by the paramedics... It's a distance from A&E problem) it would have been an efficient and probably successful resus. Second, I (as well as most of the interns I work with) am ACLS certified. I wouldn't necessarily be comfortable leading an arrest at the moment, but I could if necessary, and I would if I had to. Overall, mark it down under things I'll try to do better/not do at all.

I did have another great learning moment on call. By pure coincidence, I was in CCU to put an IVC into a patient that had (just moments before my arrival) been due for central line placement. I bumped into the anesthetist who let me stick around and see the central line go in. Now, I've ordered them before, I've dealt with them on a day to day basis, but I'd never seen a central line get sited. And now I have... cool.

A lovely day break.

So... What do you do on a Sunday night in Dublin?

I have a few suggestions:

1. Spring Cleaning. Maybe it was the sunlight and mild weather on Saturday, but I did a massive cleaning of the flat. And since the place looks and smells clean, I bought flowers. The place has a fresh look and feel... Which makes it much nicer to come home to.
   
   
2. Bake cupcakes. Much to the chagrin of my roommate, I'm working on certain baking skills, including what I'm going to call "Gourmet Cupcakes." I bake because it's cathartic, and relaxing, and you have a sharable happiness that comes out of it (as long as you don't burn it). Now, this time around I was making cupcakes for a friend's birthday... And I was putting a little extra on it. It was an experiment. I've never tried anything like it before. But I have to say, they turned out quite nicely, no? I think I'm going to be attempting a few more creative designs in the near future... In all this spare time that I don't actually have... Whatever. Watch this space. But I owe my roomie an apology for torturing her all day with the constant, "Hey, look at them now!" and then telling her we couldn't eat them yet... Sorry.
   
   
3. Catch a show. Saw a fantastic concert last night at the Olympia. First of all, they didn't lose power (sorry Coronas... I know it wasn't your fault, but that did make it a rough evening), though there was a moment with a bunk guitar... Fixed and show barely paused. The openers were a group called The Shoos - a Dublin based band, eclectic group of lads, but a great sound. I'm hoping to see them again in the future (and given that they're opening for a few more bands in the Dublin area, I'm sure I will). Good luck to them with the EP coming out in April! The Shoos were opening for Lifehouse... a band that I've been listening to for more than a decade, but have been around longer than that. Most people know them for their softer, ballad songs, but I will say this: Lifehouse ROCKED. Good job guys! Returning to Dublin for the first time in 9 years, they went through their whole catalog of music, which was brilliant... and a little bittersweet. It was almost like taking a tour through my past dating life... I've had a few of their songs intimately tied to a significant other, including songs being dedicated to me, sung to me, or being 'our song'. It would have been awkward had the songs still made me cry... seeing as the company I was in... But I do have to reiterate, Lifehouse was brilliant! They need to come back to Dublin more often. I'd see them again in a heartbeat.
   
4. Remember the closing time of the public ramp you park your car in... Yeah, that one is a little self-explanatory. Sorry for being a brat about the bill. Sorry for delaying that last 10 minutes. I'm glad we rescued your car!! It would have been fine if we couldn't, but I'm glad we did...

All these things served 2 main purposes... 1. Happy Birthday Muireann! (I hope you had fun!) 2. I'm avoiding thinking about how stressed I am for the impending SHO interview on Thursday...

New Year - New Job

Welcome to Drog, Welcome to Medicine, and Welcome to... well... I don't even know what to say about this.

The mental shift from surgery to medicine is taking me a bit of time. After 6 months of being decisive, cutting, stitching, and sending home, I've found myself with patients that on average are in hospital for months. The mean age has increased, the average amount of time with us has increased, but I have the distinct feeling that what I'm actually doing for the patients is bottoming out at less. The pace is slower, the ward rounds are longer, and the "let's see if this works" takes longer to see than in surgery.

While this is all going on, I've a few things on the front burner - like SHO applications. The most recent landmark of which was a 24hr delay in finding out about interviews. And in my mad panic, Bren reminded me that after 5 years here, I should be darn used to it... And I've come to expect it... But I'm a worrier. And not hearing anything had me sweating. Interviews are coming up soon... Ugh, I need a new suit.

On a similar vein, how the hell has it become February?! There's a part of me that can hardly believe that I'm a month into my new rotation, a month into medicine, and over halfway through my intern year... It's flying. I think in a good way, but in the back of my mind, I'm realising that I'm going to be an SHO soon. That's scary... That's really really scary.

The French are in town this weekend for the Six Nations Rugby... This does not please me. First of all, Rugby weekends make it nearly impossible to do the things you do every weekend just to keep the house running and yourself fed. Second, the French tend to make more of a mess of city centre (not rubbish mess, just walking/pedestrian rushhour mess) than the other blokes that come around. Third, some jerk knocked me clean off my feet yesterday. I've a bruise that covers the bulk of my left side (thigh to mid back) and my neck is killing me... Merde.

Monday is bringing my least favourite holiday, what I tend to call "Singles Awareness Day" or SAD for short. It's one of the worst days to be single... Having everyone remind you that you're single... At least there's a lot of good chocolate around. Mmn Chocolate!

And I think I'm going to leave it at that... Chocolate. Yum... Happy thought of the day.