This month I am working as a night float, covering for the medicine services from 7p to 7a six days a week. It's so different to what a person typically does while on the floors; I don't have to write notes, I don't have a set of designated patients to see, I don't have to do physical exams, I don't diagnose, etc... Instead this is what I do:
1. Assess and treat pain. Like, all night. I find myself wondering how patients survive nights at home, where there isn't a quick access to narcotics to treat their pain. I'm so stringent on prescribing pain meds, so I actually go up and see each patient (as time permits) and then decide whether or not to give anything. I would hate to give a narcotic to a drug seeker as much as I would hate to leave someone in pain without any treatment. It's hard to distinguish that over the phone with a nurse, so I'm doing a bit of extra work running around and addressing pain issues like, all.night.
2. The two words that freak out most nurses: "chest pain". Again, I have to assess patients that complain of that and order a few tests to make sure that there's no myocardial ischemia going on. Things got a bit crazy a few nights ago when I had 5 calls from 5 different nurses for 5 different patients within 5 minutes of each other all complaining of chest pain. That's a bit stressful. Thankfully no one has had anything serious causing their chest pain yet.
3. Parts of the night are pretty (dare I say it) quiet, but its those moments when a patient is crashing that I am in the hospital for. And that's tough. I'm covering for all medicine services (all specialties at the moment, all general services for the end of the month), and my patient load is about 60-70 patients. I can no way know all of them inside-and-out, so when one patient is crashing suddenly, I'm going in pretty blind. That's terrifying. I spend the first parts of my evenings getting to know some of the patients I think may possibly crash, but there are always a few patients that just crash out of nowhere. Thankfully, the patients that have had serious problems overnight were patients I had spent time getting to know through their charts, but I am sure there will be a night or two this month when I am called to handle a serious situation without any significant knowledge of the patient's history. Talk about scary.
4. Going along with the "critical moments", I'd like to add that I am a person who likes to sit and think and not be rushed to make a quick decision. I like to weigh all of my options and choose the best one. In critical moments, there is no luxury of time, and a decision must be made quickly. It's not that I would choose the wrong choice in these circumstances, it's just that I could choose a better choice if given the time to get to understand the patient's history.
5. Procedures. I get to do procedures with the supervision of my senior. A few nights ago I placed my first internal jugular central line under ultrasound guidance (and I got it with my first try!). That's awesome, and such a celebration. But it is so frustrating when you try for a procedure and miss (like I have done with an arterial line this week). It's hard to hit a tiny artery with that needle! ;) I'll get it this week though, don't you worry.
6. All I do is work and sleep. Ok, and I've made time to write on my blog. And sometimes I find time to shower. And I have time to brush my teeth. But anything else - everything else - has been pushed to the side. There just isn't time for me to do the things I enjoy. Yesterday, I saw a few people outside running in the sunshine while I was driving on my way to work and I honestly started to tear up. I wish I had time for those things. But I just don't. I am so tired. I hate it when people use those excuses, and I really never have before, but I'm telling you this whole residency business doesn't leave any room for life. Just ask my husband, he'll tell you in a few more colorful words how he feels about it!
Off to work another 13 hour shift. Living the dream.
(this is day 14 in a row for me, and its my last shift before my day off on saturday. thank god!)
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