Tuesday, September 09, 2008

Dealing with Being Post-Call

Saturday I came in to round on my patients in the morning, and then I spent most of the day working on my surgery questions for the oral exam. Sunday I did my laundry and all that kind of stuff that is hard to get done while you're on surgery. Later, I went in for my call night, which started at 6 PM. I had a different senior this time because the residents are on a new rotation month now. After we introduced ourselves, he told me that I could do whatever I wanted. I jokingly asked if I could just go home, and he told me, "Go ahead if you want." I have to admit that I was more than a little tempted, but I decided to stick around for a few hours at least. I mean, I was already there anyway, and the administration would probably not be too happy if they found out I had blown off my call completely.

The first page we got was for a patient who had just coded and died in the ICU. The senior had to pronounce him dead. So we went to the ICU, parted the curtains, and there was the patient, lying in bed like any other patient, except that the heart monitor and the respirator were eerily silent. My senior handed me a pair of gloves and told me to feel for a pulse at the patient's wrist. While I was doing that, the senior was feeling for a pulse on the man's other wrist. The patient had obviously just died, because he was still warm. I didn't really feel much of anything, but the senior told me to keep pressing on the man's wrist. He said, "If you wait long enough, you will start to feel a pulse." Sure enough, I did feel one after a minute or so. It was really freaky. He told me, "That's your own pulse you're feeling." Wow. We filled out the patient's paperwork and the senior signed the death certificate. I decided that I was going to hang around some more.

One of the interns was in the surgery resident office when we got back. She got paged a few minutes later, and I went with her to see the patient. This patient was a woman who was post-surgery for breast cancer (lumpectomy). We took her history and did an exam. All of her lymph nodes on that side had been removed, so she had really bad lymphedema (swelling because there are no lymphatic vessels to take the fluid from the tissues back to the blood vessels). Her arm and breast were swollen to the point that they were at least twice the size on that side versus the normal side. Unfortunately, there's not any surgical solution to lymphedema. We had her elevate the arm and told her to keep it elevated. Then we paged the senior to discuss whether the patient needed antibiotics, too. I wrote a note and the intern corrected it and gave me some feedback.

Things slowed down for a while, and I practiced tying knots a little, then just hung out with the senior in the resident office. Around 2 AM, I was getting pretty tired, so I decided to go to bed. I had to get up at 4 AM to pre-round, but at least I got a couple of hours of sleep. I wasn't feeling so hot though. My attending had clinic all day Monday, so I went in for the morning. It felt like the room was spinning, and I was pretty nauseated. I asked one of the nurses if I could lie down for a minute when things got slow, and I managed to doze off a little. My attending didn't realize that I had been on call the night before, so she thought I'd be there in the afternoon, too. I told her that I would stay if she wanted me to, but she said I should go to bed since I was post-call. I didn't need to be told twice.

This morning, I was supposed to scrub in for a vascular surgery, but it got cancelled. So I went and scrubbed in with my regular team, and it was a crazy day. We were in the OR for 12 hours, during which we did four surgeries with no meal breaks. I was really glad I had at least eaten breakfast. Today she let me suture, and I am getting pretty good at it. But now I feel too tired to eat and too hungry to sleep. The one good thing about missing so many meals on surgery is that you don't gain weight.

Here are the answers to a couple of surgery questions that I have been asked. First, yes, it really is possible to doze off in the middle of an operation. Assuming you are just standing there retracting and no one is pimping you, it's quite simple to close your eyes for a few minutes here and there. Second, needing to use the bathroom during the surgery has not been a problem for me so far. I go right before it's time to scrub in, and then since I'm often not eating or drinking anything all day anyway, it hasn't been an issue. I do come out of the OR feeling really parched though. When you first walk into the OR, it's freezing cold. But once you get gowned and gloved and those hot lights are beating down on you, it gets warm enough to make you start sweating. If the patient is being warmed by the anesthesiologist, oh wow, that really gets uncomfortable.


The Constant Complainer said...

Hey. Just stopping by. Saw your blog mentioned in the Plain Dealer, read a few posts and decided to comment. Interesting work you do.

Anyway, thanks and I will make sure to visit back. Congrats on the blog...

a.k.a. The Constant Complainer

medicine girl said...

I ate too often on Surgery! Spent the bulk of very long days in the OR scrubbed in (and I never got too hot but wished I would!). Sometimes I ate lunch late or occasionally had to make do with an energy bar, but usually my wonderful residents would either invite me to eat with them or order me to make a quick eating run between surgeries. As a result I gained a few pounds on surgery. I had to tell my residents to stop being so nice to me. :-)

CCLCM Student said...

Ha, that's a good problem to have from my perspective, Medicine Girl. Missing meals is the pits. I already had to tighten my belt by one notch because all of my pants got too big on me. Besides missing meals, I think it's because CCF is so huge and we end up walking several miles every day. I'm sure it doesn't help that I haven't been hitting the gym that much this year either. :-P

medicine girl said...

I'm confident you will be able to gain the weight back eventually. Now whether it'll be in places you like is another thing entirely. :-/

Yeah, missing meals sucks. I didn't mean to minimize your problem. :-) I always carry real food-based (nuts & dried fruit instead of soy protein isolate) 250-300 kcal bars in my coat pocket. Healthy fat staves off hunger longer by slowing gastric emptying & stimulating CCK release. Even more filling if I can snag a glass of water to rehydrate the bar in my belly.

CCLCM Student said...

At this point, I've accepted reality and just tightened my belt a notch. :-P