Rite of Passage

My 30 hour shift on call was insane. It was the stuff out of movies, or at least it felt that way. It was one of those days that I knew would happen eventually just not my second time on call. It was me and one other intern taking call on 112 ICU beds and another hundred or so in the progressive care unit. Plus we have to respond to every code blue in the hospital of over 900 beds.

It all started out fine for a few hours while I saw my usual patients. And then one died and I pronounced someone dead for the first time. It was horrible with the family standing around watching me look for signs of life and saying, "Time of death...". How do you tell someone that their loved one is gone? I'm going to be working on that one for a while. I told them that I was sorry for their loss. I filled out the death certificate and all the paperwork and continued to answer my pager (aka "cowbell" as Tara affectionately refers to it) and see new patients in the ICUs.

I had one patient actively having a heart attack and crashing while another new one was needing to be intubated and others were not doing well. So I ran around and took care of things. I was getting pretty backed up but insisted on eating dinner. While I was quickly eating a code blue was called on one of my patients. So I was the white blur sprinting out of the cafeteria nearly vomiting up my tasty dinner. It was clear the patient wouldn't survive, but I was told to try and keep him alive for a couple of hours while lots of relatives rushed in to say goodbye. So it was me, a large and hysterical family, and several nurses and respiratory therapists around the patient's bedside for a couple of hours. The family was very emotional and I tried to work with them to understand what was happening while trying to keep the patient alive. It was exhausting and went on for a couple of hours. During those hours I was getting paged like crazy with new patients to admit, other patients not doing well that I needed to see urgently.... When all the family was there I worked with the family to withdraw all support and I watched the patient slowly die. I watched a wife say goodbye to her husband, children say goodbye to their dad, siblings say their last words. I gave lots of hugs. I pronounced him, filled out the paperwork, and then had to hustle to another patient who wasn't doing well.

I talked with the next patient about his desires if his condition should worsen. It didn't seem necessary to me, but the staff I talked to suggested getting some clarification. It was tough but later proved to be important. If only medical school trained us to talk about difficult subjects with patients and families. Another hysterical family needed to meet with me to discuss their loved ones condition. I met with them and tried to discourage them from making any big decisions in the middle of the night especially since I knew nothing about the patient. I was more of a counselor than anything. I continued to move around for hours seeing critically ill patients. My pager was beeping nonstop with complicated problems.

I put a chest tube in a patient who had a large pneumothorax (air pushing against her lung causing it to collapse). I had been told that it is one of the most rewarding thing that surgeons do and I agree now. She immediately improved significantly. The crazy thing is that a relative of the patient had been at my house the day before. It is a small world.

While I was trying to work on writing notes in the morning the patient I had discussed end-of-life concerns with started coding. I became the white blur sprinting across the hospital again. There were a few doctors there but since I was the primary physician for the patient I was thrust to the head of bed. I intubated him, ran the code, and once again tried to keep him alive while his family came in. I spent hours working with the patient to keep him going, talk with the family about the situation, give hugs, answer questions.... So I kept the patient alive and tried to work with the family to decide when to withdraw support. It was super intense and went on for hours.

I worked with cardiologists, the patients family, and the chaplain to try and decide what was in the patient's best interests. I ended up having to go home before support was withdrawn but I visited them before I left to make sure everyone was on the same page.

So in one 30 hour shift I walked through the imminent death of a loved one with three different families. I had never done that once before. I learned that it is wise to bring a member of security with you to tell a family bad news. I have never pronounced someone dead, talked about withdrawing support with family members, run a code. I met with countless other families to help them understand the prognosis for their loved ones. It was one of those nights that I know makes me a better doctor- both intellectually and compassionately. It won't ever be easy to tell someone that their loved one is not going to survive, but hopefully I can become more eloquent and helpful.

There were many times during the night when I wondered what I had gotten myself into. For 29 of the 30 hours I was moving nonstop seeing patients and putting out fires. It is amazing how mentally alert you can be when you need to! I hope every night on call isn't so eventful, but I feel more confident that I can handle whatever comes my way.