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.