If the CCU wasn’t bad enough the way call was set up was down right dangerous, and everyone knew it. If I only to admit CCU patients all night and tend to existing patients it would be more than manageable. The issue was I also had to oversee the existing ICU patients and admit to the ICU all night as well. The ICU patients were ridiculously complicated. When the nurses called me about some really sick patient I had never met all I had to go on was a couple lines that were signed out to me from the other interns about that patient. For several of the calls the ICU was almost full, and the ICU pager did not stop going off, thankfully I wasn’t alone there was one other senior resident on call with me. I typically called them for just about everything. I could deal with a patient having a headache in the middle of the night on medicine, I couldn’t handle a patient whose blood pressure was 70/30 maxed out on a vasopressor drip and a failing heart.
The other edge of the sword was that the ER could hit us with a train wreck at any given moment. So the ingredients of multiple patients doing poorly on the floor, and new patients trying to die in the ER, and only two very sleep deprived new doctors to save the night from collapsing is a recipe for disaster. Thankfully this mixture never quite lined up, a disaster would present and would be managed before the next one, it always seemed like we narrowly dodged catastrophe, yet the threat was always felt.
There are of course a slew of shit show stories I could tell from call last month. My favorite, or maybe least favorite happened my last night on call. The night was actually going pretty steady, no major issues. We had admitted one patient and I was in the ICU finalizing some things in the chart. Meanwhile my senior resident was down in the ED seeing a new one. Naturally I was figuring he would call me when he needed me, as he told me to stay up in the ICU if possible. Some time went by and all four of my pagers were quiet, which is an uncomfortable feeling. In the corner of the room I overheard someone say that their pager wasn’t working. I quickly put it all together and paged all of my pagers, none of them went off. I walked around inquiring about the pagers, it turned out the entire pager system was down. This also meant the code pagers were down. I walked around and checked on my patients, after all if something was wrong the nurses would have no way of reaching anyone. As I strolled around telling nurses and other doctors about the situation, It became quickly apparent that everyone had a pretty laissez attitude about it.
I guess it's important to appreciate that in the middle of the night doctors and respiratory therapists are few and usually very far between. After I checked on my patients and I had this gloom come over me that some disaster was taking place several floors away at some nursing station tucked away in some corner. So to make myself feel better that the world wasn’t crashing in on its self I basically went to every nursing station in the hospital and made sure everything was ok and I gave out my cell phone in case something happened. Not that I could really do anything if something happened, but at least I could maybe triage and find the people that did know. At one point I went down to the ED to see how my senior was coming along and let the ED know about the pagers, again I was met with a who cares type attitude that I was having trouble believing.
After walking/jogging around the hospital again the pagers started working and I went back to tend to the ICU. The whole thing only lasted about 2 hours, and thankfully nothing bad happened. But it easily could have. I was never looking for recognition or gratitude for what I was doing. I actually just wanted someone to help me, or at least give me a better idea of how to manage the situation and no one gave a shit! It was unreal! In fact just to twist the knife a little deeper when I finally came back to the ICU one of the nurses said in a sarcastic voice “oh look here comes the hero” while rolling her eyes. I’m pretty sure I snapped my pen in half in my pocket.