Call

For ICU, call is infrequent but a killer (for me at least). We only take call once a week, on a Thursday, Friday, and Saturday, and the shifts are about 30 hours. It's tough because things are entirely unpredictable and patients are sick. Both call nights so far, I've admitted at least 3 patients, the maximum I'd admit on medicine (tonight I'm up to 5 and it's only 12:30; it's a Saturday after all). Although we only worry about sedation, pain, access, and respiratory status, I still find it busy and intimidating. Access can also take a while; it always takes longer than expected to put in an arterial or central line. Since patients are sick, there's a momentum when they hit the ICU doors and there's a lot to do for them all at once. Meanwhile, we have to worry about all the other patients in the unit whose catheters have fallen out, whose respiratory statuses are getting worse, whose families want an update. Indeed, tonight one of our patients has what appears to be delirium tremens, a dangerous form of alcohol withdrawal. His visual hallucinations were interesting. To me, it's incredibly intimidating being responsible for a unit of 20+ patients. Furthermore, things don't quiet down in the ICU; even at night, respiratory therapists are doing spontaneous breathing trials, patients are going to and coming back from the operating room, action is happening. The trick is to get sleep when you can (rather than blog, I suppose) because you never know when things will get crazy. Speaking of which, apparently there was a big fire and now we're getting a woman intubated for inhalational injury. Oh well, I wouldn't have been able to nap during the time of this blog anyway.