No Rest for the Wicked

Usually, I can get pockets of sleep on a call night in the ICU. Once things settle down, I go from room to room and check to make sure the patients are stable and the nurses don't need anything. Hopefully by warding off nonurgent calls, I can get a little bit of rest. But occasionally, a call night comes when the work just does not abate. On one of my recent calls, a patient with acute myeloblastic leukemia develops a heart attack, a patient with a recent duodenal ulcer starts bleeding profusely, a new admission from the emergency department has overwhelming sepsis, a patient whose brain is herniating needs a central line for hypertonic saline rescue, and a patient with ongoing seizures needs intubation to protect her airway. Times like this are thrilling and terrifying, and the adrenaline keeps me awake. I have to prioritize effectively with the fellow to get everything done as efficiently as possible. Sometimes, it means relying heavily on my consultants (I called the cardiologist and said, "I'm intubating someone right now, but I just found out this patient's troponin is sky high - I don't have time to give you much more information, but I'd really appreciate it if you could see the patient and help"). But I made it through the night, and more importantly, so did all my patients.