May Intern Year:
Things are busy around here. Busy, but good. I'm taking Step 3 of my boards in a little over 2 weeks. Yikes! Studying for the first two sets was hard enough when I had an entire month off to prepare. Now, in addition to working 80 hours weeks, I'm supposed to use my, uh, spare time, to study for a test. It is so much fun. Anyhoo, it will be over soon. And the more exciting piece of news is that I only have two--TWO--call nights left in my intern year!! In June I'll be working in the ER, which means that while I'll work some odd hours, it will never be more than 10 or 12 hours per shift. None of this 30 hour business that I've somehow become accustomed to. Plus, a vacation coming up. Plus, two family weddings coming up. Plus, Mary's baby will be born soon. With so many fun things on the horizon, it's hard to feel to stressed about boards. And maybe that's why I'm a little worried about it. :)
So, a few calls nights ago, I headed back to my call room in the wee hours to lay down. My pager interrupted my not-so-beauty sleep about an hour later. It was the PCCU (post cardiac care unit) callling. I knew which nurse would be at the other end of the line when I called back, and which patient it would be about, because she had called me several times earlier in the evening with various issues. I had hoped that the patient would somehow stay stable and well until at least 6 am, but as tends to happen, 4 o'clock proved to be the bewitching hour.
"Dr. *, this patient is in sustained V. Tach. Would you mind coming down here?" The question was lined in carefully concealed panic. V. Tach (ventricular tachycardia) is a rather ominous rhythm for your heart to be going in, and can lead to several bad places, one of which is six feet under.
"Sure...have you paged the cardiologist about this?"
"Yes, he's on his way in from home as we speak, but if you could come until he gets here, that would be really great."
"I'll be right down," I said as I reached for my white coat and clogs. In my head I was thinking about how much I needed the cardiologist's help in this particular situation--well, how much the patient needed the cardiologist's help, and how the nurse knew that too. But the fact that I was coming down until he got there was going to make everyone feel better until he arrived. That's the magic of the white coat. Luckily, he arrived shortly after I did.
The patient looked remarkably well for someone whose heart could peter out at any moment. She was alert and talking. Pleasant, even. We gave her several boluses of a drug that should/could help her heart to convert back into a normal rhythm. No such luck. We waited and tried again. Waited and try again. Ultimately, there's only so much time you can spend waiting and trying again before you have to manhandle the heart. We needed to deliver a shock.
In addition to pulling in the crash cart, we called the anesthesiolgist to help sedate the patient. Despite what you've seen on ER or Grey's Anatomy, a good number of shocks are actually delivered to alert patients who might really hate you if they were cognizant for the electric parade you're sending their way.
The cardiologist turned to me. "Would you like to deliver the shock?" "Sure!" He said it in a voice that indicated he felt like this was the least he could give me for my trouble. i.e., 'this poor resident has been up since 6 am yesterday...we can at least let her do the fun part.' I appreciated it.
We put the pads on the womans chest and back, waited for the sedative drugs to kick in, and charged up the machine.
"Everybody Clear," I said in a voice that lacked that unmistakable televised-like drama.
And then I pressed the button. With my thumb. Apparently, that's unusual.
The patient's chest arched up off the bed as the rest of her body went rigid, and then she fell back onto her pilllow. We all looked at the monitor. A beautiful, sinus rhythm was there as a reward for our efforts. The anesthesiologist woke the patient up, and she was happy to learn that the problem had apparently been resolved. We put our equipment away, and I headed back to my call room.
The next morning around 11 am, I was just finishing up some of my chart work on some patients, hoping to get out of there soon. The same, very kind cardiologist from the night before was walking by. "Hey, OCM...do you want to shock someone else? I'm just on my way there now." "Uh, sure!" It might have been the end of a long shift, but it's not really the kind of thing you say 'no' to. Maybe he figured my thumb was on a roll.
This time the patient was a gentleman who had come in for a planned cardioversion. He was in an abnormal rhythm that, while not great, wasn't imminently dangerous. So I went in, and ran through the same routine as above, albeit with even less of an edge. It can all seem so ordinary until you stop to think about it. "Hi, nice to meet you. I'm Dr. *, I'll be the one electrifying you." Ha ha ha. I have to admit that you feel like some kind of mad scientist when you push a button and then watch somebody's body convulse up off the bed in response. You know you're doing something beneficial, but it feels a little sadistic.
Well, I'm off to bed. May you all have very un-shocking evenings. :)
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