Wow. Just wow

I'm now 7 calls into 4 weeks into q3 call. It's a 6 day call cycle, with a 30 hr shift over the first two days, then the third day is a normal 8-6 ish day and then a 30 hr shift and then a day off. It gets brutal after a while.

The MICU at the hospital is small. So small that the other units make fun of it. It's kind of like the movie "Das Boot":



The "MICU resident 7-0" (a call holding on extension -70) comes on the overhead more than you would like. While it means work, it has also has the highest proportion of hit-to-miss ratio in the hospital. As in, calls worth your time because of sick and/or interesting patients versus just other hospital bullshit. In my 2 weeks, I oscillated two people, both of whom are now extubated, one of whom has left the hospital on room air. That guy had acute rejection after a lung transplant. The other was a 3+ sick lady who we diagnosed with Goodpasture's syndrome. She came in on maximal vent settings after walking into a community hospital 3 days prior with a slight cough. Admitted at 8 PM, we oscillated her, had her on maximal life support, pulsed with steroids overnight. By 1 PM the next day, she had a kidney biopsy, she was diagnosed by 5 PM, had plasmapheresis by 6 PM, and cytoxan a day later. She was extubated after 10 days on the ventilator. It was kick-ass.

Now I'm in the CCU. We have absolutely crazy physiology over there and I'm learning lots. But the call schedule is absolutely brutal. That, and it seems like every call I'm totally thrown for a loop. Last night, I watched a very pleasant woman walk in with a blood pressure of 270/170, then drop her blood pressure to 110/70 with almost no intervention (it had been 2 hours since her last dose of BP meds), become obtunded, started pressors, called the Brain Attack Team (kind of the neuro code team), intubated her, sedated her, CT head, MRI brain and neck. I still have no clue what's going on with her but it is sure intriguing for pheochromocytoma or VIPoma. Or maybe just she just vaso-vagal'ed or something.

Though, it is time for it to be done. Call on Friday, then again on Monday, then I'm done with call. After 90+ calls in my intern year, and probably 50 or so in each my junior and senior years, it seems like the day would never come.