August 26, 2009

• Business As Usual

  As I filled up my tank at the gas station in downtown Hollywood on the way to work today, a balding white dude pulled in, put his blinkers on, and made a cell phone call. Then a youth with a small bicycle and a large white t-shirt rode up, dumped the bike, got into the car, and quickly exited and cycled away as the man drove off. It all took about fifteen seconds, so maybe he was just saying hello? And he had to do it all up close and personal. And he probably had to give the guy a little baggie, because he knows how much his friend likes to organize all his small items, and then he asked for some ice-cream money and the balding guy was happy to oblige on this beautiful summer day. Yes, that’s probably it.

  
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  Somewhere around 1 or 2 AM (it can be hard to tell) I got a call to go check on a patient who the previous night had a “pseudo code”. A pseudo code is when a patient for one reason or another becomes unstable enough that a code is called, but by the time everyone gets there it is canceled. This is usually due to respiratory more than cardiac issues.

  But I digress. According to the nurse, the previous night the patient had some mild vomiting and when he was turned on his side, he went into a brief respiratory (not cardiac) arrest. This current night he had also had some mild vomiting, so the nurse wanted to give me a heads up. Because nurses are awesome like that.

  Sure enough, probably not even an hour later, a code was called and we all rushed in, me thinking a proper doctorly “OH CRAP OH CRAP OH CRAP SOMEONE GET THERE BEFORE ME” only to find that the gentleman had once again had an apneic (he stopped breathing) episode. Of course, this one was made all the more disturbing because since this had happened the previous night, he was already on a facemask with 100% oxygen when he had this episode. An ABG (arterial blood gas) demonstrated a pH of 7.074 O2 of 61.2 and CO2 of 107. Yes, fellow meddites, you read that correctly. and Laypeople, that is ludicrously high. Practically non compatible with life high.

  In case you are wondering, you bet your sweet fanny I went straight up the ladder to the Hospitalist to confirm any ideas I even thought of having. And he concurred that the patient should be intubated and transferred to the ICU, at least for the night. Remember my job on night float is to keep everyone alive til MORNING. What they do after I go home is someone else’s problem

  Then the fun began as I had to explain to the family what was going on and why, as family remained convinced that they should have just taken the patient home with them and he was doing fine until the doctors got at him, and isnt putting a tube down his throat dangerous on all the tv shows, and he was the picture of health not even a day ago and the like

  Sometime around 4:50 AM I finished all of this and realized my dinner was still down somewhere in the residents lounge unfinished, lonely, cold, neglected, and unlikely to fulfill its destiny.

  Guess it’s my breakfast now.

  • 7:50 am
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