#the sentence ‘I left the ICU to go home for a shower at 2 am and I’m worried my car might break down trying to get back’ is pretty bad huh

[justaboot]

Day 3

[flyonthewallmedstudent]

A night in the life: Night shifts

[NB: all cases altered and de-identified, to point of being generic]

2100 hrs: Handover time.  I’m on subspecialty cover for nights. As a rule where I work, no interns are allowed to cover a few of the subspecialties with potentially higher numbers of critically ill patients. Not all hospitals are like this in the area. At any rate, it means I do a mix bag of jobs, from your run of the mill answering of pages to admissions, to attending codes for affected patients.  - I get handed over a patient at risk of deteriorating - 2 codes in one day for hypotension, in setting of a diabetic limb - they’re also post op day 5 of a mid foot amputation. ICU is full, but so far their BP has been holding after the last fluid bolus. They’re also on 3 different IV antibiotics. Asymptomatic. Teetering. But stable. - pager goes off. Need a sleeping tablet for one patient. Analgesia for another, no PRN ibuprofen charted.  - one sick patient handed over and a couple of light pages, not a bad start to a night. on bad ones I might have 3 admissions lined up and 2 expected admissions from country.

2130 hrs: - prioritize the jobs and head over to see the sickest patient I have, and eavesdrop on the nursing handover for this particular one. Then call the night shift ICU registrar/senior resident, to discuss, but coincidentally, they’ve also arrived to assess. In the event of a code, we both now know the patient and scenario. - another patient reports 7/10 pain D3 post op amputation, just started on ketamine infusion that morning. Then they fall asleep mid sentence and start to snore.  - quickly answer some pages, and give phone orders where I can. 

0000 hrs - notified about a transfer from a country hospital. needs admission.  - reminds me of the forrest gump quote, life is like a box chocolates, never know what you’re going to get. and that’s exactly how i feel about country transfers. you get some of the story over the phone, but you never what actually comes through the door until they arrive - it’s pyelonephritis of a renal transplant graft, with AKI in a 22 year old.

0100hrs - A concerned ED doc calls. New admission - patient with diabetes, but is not on treatment, who has necrosis or gangrene in the foot. Patient came in with a temperature and trouble breathing - they were in fluid overload too. They argued with their kids who called the Ambulance, who noted that the toes were so black, they looked like you could just snap them off. ED puts them on some of the strongest IV antibiotics under the sun. they’ve also notified the surgeons. - the patient in their 60s, had been treating their foot with tea tree oil, last saw a doctor about 20 years ago. They tell me they don’t believe in doctors and don’t want therapy - i later learn the patient was adamant about no further antibiotics, no diuresis, no surgery, nothing. they were palliated and died shortly after, of their own accord. - it reminded me of a couple of other patients I had. patients with advanced cancer whether lung or breast, or other major medical conditions. who refuse all treatment opting for homeopathy instead. Until at last, unable to cope at home they come to hospital.  - in the end what we see is the natural progression of their disease. diabetes left untreated, heart failure left untreated, congenital heart disease, breast cancer with metastases to lungs, brain and bone. things you read in a text book and never expect to see in the age of modern medicine. but we now begin to see them all again, just like all the paediatric diseases we wouldn’t expect to see in the age of vaccination.

0200hrs: - paged to place an IDC into a delirious patient with urinary retention to 1L on a post void bladder scan.  - I used to be slow and nervous about IDCs.. but after so many night shift requests for these.. I can do it under 10 mins now. Sometimes 5 mins if I’m really pressed for time and the nurses have already set up for me.  It’s almost always awkward for the poor patients, but for me.. as one resident said, “it’s just another elbow in medicine”.  - I reflect later that I’ve unintentionally seen possibly 100s of naked men on this job now. And handled their genitalia to put foley’s down too many times to count, I never thought that would happen 10 years ago. If you’re squeamish or prudish about sexual organs, this really isn’t the career for you. - a lot of older men go into urinary retention when they’re unstable or after surgery. - few more pages about hard cannulas on patients with no ‘veins left’ etc.  at 0230hrs I hit the night shift coffee truck that pulls into ED. In queue are other residents, nurses, construction workers from a site next door, police officers. etc. there’s nearly always police officers in ED nowadays, often just babysitting outside a cubicle. a few months ago there were a couple of public service campaigns on hospital violence.

0300hrs: - page about a patient with tachypnoea after a bronchoscopy during day shift, despite 3 L of O2 via nasal prongs. - The saturations fluctuate between 88-93% (when they were previously 100% a week ago) recent diagnosis of PJP pneumonia in sputum PCRs. They’re a transplant patient on immune suppressants. - I take a blood gas, they’re in type I failure. but their saturations pick up with high flow. I briefly chat to an ICU registrar/senior resident, for extra support or advice. happy with high flow, wait till morning for a respiratory team review. we stress dose them with steroids.

0400hrs - another page, another admission -- 25 yo out on a saturday night, too many shots of tequila. in the setting of binging every weekend since their teens. they woke up with melaena and small vomits of frank red blood in the shower. ED starts them on PPI infusion, Hb is stable and their vitals are stable. They’re booked for an endoscope in a few short hours. - I hate counselling someone close to my age on drinking habits, I do it anyway. Remembering the night before I was having to have a family meeting with the family of one patient in liver failure at 2 am. they’d been drinking heavily for 20-30 years. They had portal hypertension, haemorrhoids. And they were coming in encephalopathic for the first time. It’d been a while since I’d seen such an emphatic hepatic flap. I forget sometimes, most of the general public have no idea what liver failure is or what it entails. It’s hard conversation to have.  0430hrs:  - I review the sicker patients on shift briefly and get updates from the nurses. Reassure junior ones looking after the sicker patients about plans and vital signs. 

0530hrs - things are settling. I eat an apple. It’s actually rare for things to settle, usually I’m catching up on smaller jobs. It hasn’t been a bad night. I contemplate catching up on studying for boards or research, but end up typing up some discharge summaries for day shift teams. Knowing how much it means to them having a couple of summaries ticked off. 

After a time, it’s teaching and handover time.  It’s nice to see ‘people’ again, the ward clerk, day shift residents & nurses all pouring. It’s like an invisible bell has gone off somewhere, as if to say ‘school’s started’ or something. Sometimes I forget how lonely nights are until I see them piling in. After a few moments to handover and a couple of ‘have a good sleep’s’, they turn to their computers, and hunch over. Looking intense, bracing themselves as shifts begin for them. 

[foursprout-blog]

You Saved My Life And I Don’t Even Know Your Name

New Post has been published on http://foursprout.com/happiness/you-saved-my-life-and-i-dont-even-know-your-name-2/

You Saved My Life And I Don’t Even Know Your Name

Nicholas Kwok / Unsplash

I see you sometimes. You’re the kid the same age as my little sister who’s crossing the street as I sit in traffic at a red light. You’re the guy whose laugh everyone noticed in the busy restaurant last night. You’re the barista who gives me a large instead of a small. I want to know you. I want to know your family. I want to know what your dreams are. Where do you see yourself in ten years? Do you want a family? Do you like dogs or cats more? Are you a cheese person? Because I can eat a wedge of sharp cheddar at an alarming rate. Can you belt out disco music at the top of your lungs in the shower like me? Do you have brothers or sisters? Are you happy? Are you in love? Then the car behind me honks and shouts because the green light is close to fading to yellow and I realize I’ve been daydreaming about you again. I don’t know anything about you. Not your favorite color. Not the band you listen to on repeat. Not your birthday. Nothing, not even your name. I think about you more than I care to admit. I have all of these questions I would give anything to have answered. But then I remember the question I’ve been asking since you saved my life.

How did you die?

As I write this, there’s a prescription bottle to the right of me. This one pill that I now take will be a part of me until the day I die, just as what you gave to me will be with me until that same day. This little white capsule keeps the organ you gave to me without fear of rejection. I don’t know why I’m telling you this. Perhaps it’s to distract myself from the fact that I have no idea what to say to you. How do I thank you? How do I honor your death? My God, I wish that I could tell you that I will find the cure for cancer, write something that helps bring world peace, or do something spectacular with this second chance. But I’d be lying if I didn’t tell you that all I want is to be healthy. And thanks to you, I’ve become pretty good at that.

69 days was all it took. Day one, I walked in with what I thought was a nasty cold paired with a possible urinary tract infection. Less than 10 weeks later at the ripe age of 25, I was waiting to die in a hospital bed in the ICU. But then, my dream team came in and told me about a young man whose liver would fit me perfectly. Yours. Eight hours of surgery later, you had saved my life. I went in for surgery on Wednesday night, and I came through the other side on Friday morning. After tubes and bandages were pulled and ripped from my body, they walked in, my mom and my kid sister. That feeling of them being allowed to hug and hold my face is something I will never forget. The tears and the happy sobs of gratitude. To look into their bloodshot eyes. The smell of coffee and relief on their breath. The warm sun was coming through the windows on that cloudy January morning. I have never felt such love for life. When I think about that moment, I often think of your family and what may have been the worst moment of their lives.

I was never told your name. Everything has been kept confidential. I’ve tried writing your family, but I thought that writing you may come easier. “Male, age 21” was all that they would tell me. The first thing I thought of was my sister. You came into this world the same year that she had. And naturally, my next thought was of your siblings and what you must mean to them. The very idea of losing my little sister makes even inhaling hurt. If roles were reversed, I would have given my life up for hers in the blink of an eye. You see, my little sister is my favorite person on this big ball of blue. She’s funny, and she ’s strong, and she’s just the best person despite everything that she’s had to endure. And now, she was going to have to face my death. Before you came to save the day, no one could sit with me and act as if things were normal, until she came. My sister was the only one who could still put a genuine smile on my face. Even on what we thought could be the last days of my life, she made me laugh. She crawled into my hospital bed, held my hand, and we took selfies. Silly, I know. I think of her and how my life would never be the same without her. She was my very first best friend. I can’t help but think of what your brothers and sisters must feel. So I promise you that I will be the best big brother in the entire world to her. I will love her when she comes home with a new tattoo or falls in love with some idiot who isn’t worth her time. I promise you that I will hug her tight every time that I see her.

We were left with the question of “how?” How did you pass? Was it sudden? Was it an accident? Did a stranger not call an Uber after too many drinks? Was it the rain we had been having? Were you out with friends? Celebrating a belated new year? I guess it doesn’t matter. I wish I knew your name though. So much so, that I’ve given you one despite never knowing a thing about you. I call you Sam. No particular reason to be honest. I was at a concert and the artist’s last song she sang was by the same name. I fell in love with the song and what it meant, and you came to mind. It was meant to be. Sam. I say your name a lot these days. Often times, when I’m doing something that I don’t want to do or a task which is proving to be difficult. Getting out of bed on a workday. Making it the last five minutes on the treadmill. Or even something as simple as taking the garbage bins out the night before. I think of you and say your name because you will never have the chance to do such things again. These “burdens” are a blessing to me now. I remember being in the hospital post-transplant and my discharge date kept being pushed back further. And further. And further. I could not wait to get out of that sterile hospital room with its fluorescent lighting and not just be alive, but honestly living. Eat real food. Hug my family. Order a cup of coffee. Pay a utility bill. Take my dog for a walk. Deal with these everyday burdens. And then I would think of the good parts. Like being stupid with my two best friends.

It took 11 days for them to come and see me after the transplant. They kept me sane, loved me back to life a time or two, and got me out of my head long before being locked in an ICU and being told that I was going to die. In reality, these two people who I’ve shared my life with know me differently than anyone else on this planet. They can take one glance at me and know something’s off. They each can call me on my shit when no one else can just as they can make me laugh so hard that tears flow freely down my face. We have walked beside one another during the very worst moments of our lives. Have no fear; they have also been within an arm’s reach during my most cherished memories. When my body was healing with seventy-seven staples keeping you inside of me, they would send or say things that nearly split the stitches from too much laughing. Thank you for that. There would be no laughter with my two best friends if it weren’t for you. I promise to keep laughing and to hold them close. I promise to never keep things from them. I promise you that I will love them until the three of us are old, wrinkled grumps on some porch together talking about the days of our youth.

Of all of the people who have felt your loss, your mother comes to mind most often. Likely because of what mine means to me. Before I was diagnosed, the thought of death did not terrify me. I’ve lost people and the tears would always come, but somehow, a thought of knowing that they were going to be okay would find me. Their spirit is only shedding its body. When I was told that I was going to die without an organ such as yours, a fear I had never known grasped me hard and would not let go. It was not a fear of dying, but a fear of the life that I had yet to live. I had so many things that I wanted to do, so many things that I wanted to see, and to hear, and to experience. I was not ready to die. My mother was holding my hand when the doctor gave me a death sentence. And all I could think of was not being there for her. To dance with her at my wedding. To introduce her to her grandchildren for the first time. To tell her that everything was going to be okay. To never come home again. She was the first one I thought of when I came out of surgery and was conscious. Before they had removed the breathing tube or had taken the tape off of my eyes, they put a pen into my hand to write questions. All I could write was, “Where’s Mom?” Where is she? Why isn’t she here? And before I knew it, she was. I think of your mother and I cannot fathom the loss she has in the center of her being. I want to thank her, but at the same time I want to apologize. I want to tell her that I’m sorry. I may never find the cure or the reason as to why you were taken from her and why I was given a second shot. I’d hug her and I’d probably cry because this whole dying thing has made me an emotional fucking wreck. I promise that I’ll thank her and the rest of your family. I promise to tell her that her baby’s life will not have been lost on me. I’d ask her about you and I’d soak it all in. All of it.

At the very least, I promise to ask her your name.

But until then, I will call you Sam. And I will live for you, Sam. When fear grabs hold of me and keeps me from doing something, I’m going to do it regardless. I’m going to do it for you. As my fingers type these words, I glance at the calendar next to me and see the date. In two days, it will be one year since you saved my life. To say this past year has been an adventure would be putting it lightly. I fought hard. I cried more than I would care to tell you, but most of these tears were happy tears. I am still lost and pondering why this happened. I still think about you, about your family, about life before that dreadful diagnosis day in November. Up until recently, I wasn’t big on making plans for tomorrow. Or the next day. The thought of making plans and thinking of the future had become something only others got to do. I couldn’t think of that when I must be grateful for merely this very moment. How could I want for something years down the line when it was a miracle to be here right now? And then one night after hearing of a friend gone too soon, in walked my old friend Fear. Fear of getting sick again. And as I sat there crying with hands shaking, someone very close to my heart told me that I could no longer be afraid to plan for tomorrow. Is there a chance that I will get sick again? You betcha. But I’ve decided to pull out my planner despite that truth. So this is my promise to you. I promise to get stronger than before. I promise to fall in love again. I promise to get married, and have babies, and travel this world, and dance to Donna Summer with a block of Tillamook in hand, and hug my people a tad too long. I promise to meet your family one day. I promise never to take my loved ones for granted or forget the beautiful burdens for what they are, a gift. I may not save the world, but you saved mine, and I will always remember that.

Promise.