Busiest 30 hours of my life

I wanted to tell a story about on night of call that I had sometime during the past 4 years.
It was like a comedy because of the horrific things I saw, the sheer stress I was under, and the complete exhaustion I experienced.

It all started off by oversleeping and not getting to the hospital until 5:15am. Bad way to start the day. Saturdays are definitely the worst day to be on call because it ruins your weekend, the list of patients is enormous and then everyone needs to be discharged. I rounded and wrote notes on around 13 patients, which isn't that bad for a Saturday morning, actually. However, I didn't know a bunch of them. The first guy I saw was the typical patient: older than hell and sicker than hell, and to top it all off, completely unresponsive. Great. Sorted that problem out and then I rounded on the rest of my patients without having any time to write my notes, of course (that will come later). I get down to the cafeteria to "sign out" our patients (which means running through the list of 60 patients we have so that we all "know" about them). This process usually takes 1-2 hours. Of course during this time we have our first trauma of the day.

Trauma #1 - Transfer from community hospital. Drunk guy coming home from the casinos flips his SUV and has a C7 facet fracture, i.e. he had a stable neck fracture. However, he also sliced open his scalp from the tip of his mid forehead to his right ear and I had to numb up and then staple up. That took over an hour to do.

Of course during this trauma, I was paged at least 10 times for various things to do on the floors. I then attempted to finish up my notes and write some orders for the patients, in between the countless interruptions I received from pages. I wish that there was some way I could express how frustrating it is to get beeped every few minutes to mostly answer the same questions over and over again. But I can't because you just need to expereince it yourself.

Next project that was given to me was to change the dressing on a patient with Fornier's Gangrine, which for those of you who don't know, is necrotizing fascititis of the perineum, or more simply put, the flesh eating bacterial infection of the area between the scrotum and anus. The treatment of this disease it quick and very wide debridement of the diseased skin. In other words, all of the skin below his penis is gone. That's including his scrotum, the skin around the anus, the perineum (taint, grundle, etc.), and much of his buttocks. His testicles were freely hanging individually without a scrotum to contain them. So under conscious sedation, I unwrapped each testicle individually and removed the packing from his ass and changed it.

So that took up another hour at least. Then I tried to discharge some patients. We had about 10 who were leaving and that involves writing instructions, filling out prescriptions, and dictating a discharge summary summarizing their stay in the hospital. I've gotten very good at quickly breezing through them, but again, with interuptions every 5 minutes, it's kind of difficult. The worst part about the questions the nurses asked me were that I just didn't know the answer to them because they were about patients on a different team. Fortunately I could just ask my midlevel resident or chief resident, but oh, that's right, they're both in the OR. It will just have to be put off.

Get a consult to put in a central line. I go do it myself, and get it on the first shot! Whoo hoo! Something good about the day! She was comfortable, all 3 ports worked, and everything was great until...

Trauma #2 - Another drunk driver got into a car accident. I walk into the trauma bay and on the other side is an intubated blue faced 170 year old woman with a blood pressure of 30 who was, of course, being given all recussitation measures until the family could come to grips that their dying, great, great, great, great, great, great, great grandmother-in law was finally ready to die. Luckily, my patient was the drunk upstanding citizen next to her with the blood gushing out of his head. He seemed to have a minor scalp laceration, until we realized that there was a puddle of blood below his table. Oops, better fix that one up. So I got a suture and sewed up his head and stopped the bleeding. All right! That's 2 for me today. Of course I'm saturated with his blood so I have to go change my clothes while he's getting his several thousand dollar workup that he won't pay for, doesn't want, does not appreciate, and is completely unnecessary but is the accepted protocol.

Next, I get a call saying that one of my patient's chest tubes fell out and was on the floor for several hours. A chest tube is a life saving tube that it put into the side of someone's chest when they have a pneumothorax, aka a collapsed lung. This re-expands the lung. A collapsed lung is a medical emergency, simply put. Now that her chest tube was on the floor, we had to act quickly to make sure that she was ok. We got a STAT chest xray and of course, her lung was fine, but we needed to put the chest tube back in there to drain out her malignant pleural effusion. She was not too happy to have to go through that experience again, which involves making an incision in the side of your chest, sticking a clamp in between her very narrow ribs, puncturing through the chest wall and into her pleural space and spreading the intercostal muscles to make room for the chest tube. Oh, did I mention, she's completely awake for all of this? Sounds barbaric? Well, it's not if you're able to numb them up properly. We did, luckily, and she was very grateful for it. All right, another good feeling for the day!

Now I finally got some time to eat some dinner (holy crap, it's 7pm already). Somehow we managed to all eat dinner together without interruptions. There must have been something wrong with the pagers.

I finally get a chance to check the labs on my patients, or at least some of them. Of course all of the ones that I check are abnormal and need replacement. I order most of them but the one old lady who needs the most has her only IV access leaking. I have to change her central line over a wire but I can't because there just isn't enough time.

Then I decided to go post-op check the patients who were operated on. Keep in mind, that during all this time, I am getting paged every 5 minutes.

Then we hear the dreaded, "trauma team, STAT to the trauma room! Trauma team STAT to the trauma room!" That's never good.

Trauma #3
A kid was shot multiple times through the chest and abdomen and was crashing right in front of us. We ran the ATLS protocol and put in 2 chest tubes, I put in another central line (again, on the first shot, with a blood pressure of 60 - not too shabby, if I don't say so myself). But he started crashing fast and we knew that he had to find the source of his bleeding in his chest. So right there in the emergency room, we opened up his chest. It's called an "ED thoracotomy". It was the most unbelievable thing I've ever seen. We made an incision from one side of the chest to the other and opened it up like a book. You could see his heart beating right in front of you and his lungs inflating and deflating. Someone started manually massaging the heart, we clamped his aorta, and we quickly rushed him off to the operating room.

On the way to the operating room, we hit a bump, and a bag of blood got disconnected and splattered all over the stretcher, the patient and all of us. This was in the carpeted hallway, by the way. We all just froze and I ended up grabbing it and taking it off the pole. We quickly whisked him up the hallway, leaving a trail of blood behind us that some lucky person had to clean up (it was clean by the next trauma).

In the operating room, we opened up his abdomen to try and find the intrabdominal source of bleeding. There were bullet holes through the intestine, so we removed that, but that was it. So we turned our attention to the chest and pulled back his heart and lungs to see a big hole in his superior vena cava. We sewed that up and then noticed many bleeding lung injuries which we then removed as well. He just kept on bleeding and I kept seeing his heart getting slower and slower. Then he went into DIC and blood started coming out of every orafice.

Somehow we were able to make it out of the OR and to the ICU where he died. As we were in the ICU, the cop, said to us, "oh by the way, there's 2 more coming in," and sure enough we get called down to the trauma room again.

Trauma#4 - A young guy who was shot 3x in his thigh. Miraculously, nothing was really injured. He got his million dollar unappreciated workup as we turned our attention to his next door neighbor.

Trauma #5 - Kid shot by a shotgun 15 feet away. He was sprayed with at least 50 pellets all along his right hand, arm, thigh, and even in his penis and scrotum. Again, nothing deep was injured.

Both of these guys got admitted and it's about 3 am now and my senior level and I decided to finally run through our list of patients. However, I got 4 pages and the first one that I answered, I just snapped and was pretty mean on the phone. She didn't really like it either and she yelled back at me. I felt really bad and right after we ran the list, I apologized to her. I really like the nurses here and her in particular. I could not beleive what this job had done to me. I have never been a rude person but I just couldn't deal at that moment. I just wanted 1 hour to myself so I could possibly rest, but it was not possible. But, I really felt terrible and I think that she forgave me. I hope so.

I decided that it was so close to the time I would have to round on my patients for the next day, I might as well start now. So I was almost done rounding and writing my notes and I would have been able to sleep for at least 1 hour and I hear "trauma team, STAT to the trauma room." Shit.

Trauma #6 - 360 pound man stabbed in his side with a piece of intestine hanging out. If that wasn't bad enough, his feet were the most foul smelling things I have ever smelled. I had a mask on, and we sprayed them with bicarbonate ( which I guess helps stink foot) but it was overpowering the trauma bay. That stench will stick with me to the grave. He was taken to the operating room and they repaired his diaphragmatic rupture where his intestine were up in his chest.

So I finally rounded on my patients, and signed out, and actually changed that old lady's central line that I never got a chance to do.

I did not sleep at all. It was both physically and emotionally draining. It was by far the busiest 30 hours of my life.