I have been working in a huge hospital complex since July 1rst. No internet access at my house yet. So far I have been on call for 7 nights with getting to the hospital in the beginning at 4 am. Now that I am getting faster I am going about 6 am. I think the other residents are showing up about 7 am but as an intern I round on most of the patients for the general neurology service which is about 10-12. When I am on call I get to the hospital about 6 am and get off about 1 pm the next day. Usually I can get 1-2 hours of sleep. I have been working up to 115 hours a week . They have call rooms on the ground floor but I usually just go to a conference room on the 8th floor of the hospital and pull three or 4 chairs together which I have found makes a very nice bed because they are flat with no arms and pretty well padded. What happens is that I "cross cover" for the other neurology services which include a veterans hospital which usally only has 3 or 4 patients and for the stroke service which has up to 15. These patients are usally really sick to begin with on top of the fact that they have had some kind of stroke either a hemmorhagge (bleed) or a clot (ischemic). The calls I get are somtimes for mundane stuff like nausea (I prescribe pherergan or zofran) to drops in oxygen saturation and vital signs like heart rate, respiration, and chest pain which require a cardiac workup for heart attack or possible intubation. The cardiac workup includes an EKG and serial cardiac enzymes that indicate whether the patient has actually had a heart attack, a chest x-ray, and giving morphine and nitroglycerin for pain as well as aspirin to help prevent clots (anti-platelet action). The way it works is the nurse first calls me and I try to fix the problem. If I can't fix it or feel uncomfortable with fixing it by prescribing meds or getting a consult from another service like cardiology. I call my upper level resident and he tries to fix it or order studies or give treatment. If he feels uncomfortable he calls the attending physician. So I get tons of pages on patients and have multitudes of nurses that call me and ask me what to do even though I have only been working in a hospital for a couple of weeks. They usually have a good idea what to do about the common stuff and sometimes just call to get permission to do something. Other times they don't have a clue. I look stuff up and if I can't figure it out I either consult another team like cardiology or opthomology or neurosurgery. At about 8:45 to 9am the whole team "rounds" on the patients with the attending physician. He makes recommendations and writes stuff on the back of my note. We keep a list with the important stuff about the patients because noone can remember all the tests and things that are needed to be done and results checked which is updated periodically. At the end of the shift we "check out" to whoever is on call for the night. I get a 60 dollar on call allowance per month and they scan my badge. The food is real cheap and they have a grill that is open 24 hours. Also they have some healthier food during regular working hours in another building which is called the clinic building which is actually pretty good. The types of patients I see include ones that get gullian barre for example where they become progressively more paralyzed starting from the feet and working it's way up the body until they potentially lose the ability to breathe in which case they have to be intubated. The good thing is that it is temporary and can be treated with an immunoglobulin so they get what is called IV IG. Also stroke patients get clot busters but I havent' been on the stroke service yet. Other disease include meningitis. One patient we are seeing now has cryptococcal meningitis which has eaten a huge hole in his brain. Cryptococcus is a fungus and he is being treated with a very toxic antifungal drug called amphotericin B. Other patient we have include a guy wth Korsakoff syndrome caused by drinking too much alcohol and no food with the vitamin thiamine. It cause him not to remember things that happened just a short time ago. To make up for this he uses cofabulation. For example the attending comes in and says Hey MIke! Great to see you at the pool hall yesterday!!! and the guy says oh yeah Hey great to see you too! even though the guy has been in the hospital for the last month. Other types of patients include people with increased intracranial pressure due to too much production of cerebrospinal fluid which starts effecting their vision for example pseuodtumor cerebri which can be attempted to treat medically with drugs or may require a shunt be placed surgically into the lateral ventrical of the brain which goes from the brain to the abdomen and drains into the peritoneal cavity. Other cases include severe seizures that cause what is called status epilepticus where the patient continues to seize for over 5 minutes potentially causing inability to breathe for which they may first be given ativan a benzodiazepine to try to break it and then possible loaded with a large dose of anticonvulsant. Other cases include myasthenia gravis where the patient has progressive muslce weakness and must be treated for example with IVIG as in guillan barre syndrome. Other cases include spinal tumors causing paralysis and brain tumors causing focal neuorlogic defictis that must be diagnosed by MRI imaging.
i take it back. doctors aren't necessarily idiots. they just lose all of their brain cells during their internship and residency because they work 115 hours a week. no fucking wonder - if you don't let your brain and body rest, no wonder lots of doctors seem like complete idiots. get some sleep, dan. sounds like you're enjoying saving the world.
We get 1 day off per week and today is my week. It isn't quite as bad as it sounds. After a 30 hour shift on call I go home and sleep from about 1 til 5 and then I get up and go back to sleep and sleep from 10 to about 5:30. So I'm usually not a walking zombie except for when I get to about to the 25th or 30th hour on a call day. I have started to doze off at the red lights by that point on the way home. Some of the nurses are pretty hot and so it's not that bad getting called all night especially if they are super hot. I usally spend more time helping the hot nurses patients with minor problems if that is the case after they call me with their active assistance of course. It's really the though of my new Jeep with it's killer navigation system that tells me where all the different types of restaurants and rest stops and stores and whatever are that keeps me happy as well as the thought of my new house with it's big back yard and the thought that I will make alot more money when I'm done.
