Monday, 3 March 2014

Nights


Hi,


Just completed a set of nights, and I am still unsure as to whether I enjoy them. The positives are that there seems to be a good team attitude of 'we are all in it together' from the other doctors and nurses during the night, and you get to see quite a few ill patients, which means trying to work out what is wrong with them and hopefully putting things right. This is a lot more active for the brain than my daily job, where the consultant does most of the thinking and decisions, while I spend time following orders and filling in paperwork. Sadly there are negatives as well: I get really tired, and then after the nights I cannot sleep properly for the next week or so as my body clock has flipped; there are very few seniors in the hospital to help support with the above decision making, so if several people get sick you are going to have to be confident in your initial management as it may be an hour or two until someone more senior can come and review the patient; there is also the flood of menial jobs from the wards which have been forgotten by day teams (like writing up regular medications) - sadly all of this cumulates in very large sentences...

While I was on call over the week, there were quite a few sick people on the wards, sadly 2 of these people died. It was difficult to try and manage multiple ill patients as it involved heading between different wards to try and manage each patient while trying to answer the random bleeps that kept coming though (such as one patient who kept having 4-8 second pauses on his heart tracing without any symptoms. Very scary!)



Parts of the ECG for the asymptomatic patient with the pauses. In the end the cardiologists put a pacemaker in, but scary stuff (for me, he didn't seem to notice) overnight!

The craziest part of the night was when I arrived on the gastroenterology ward to write up a new drug chart, as the old one had somehow been lost when transferring the patient from another ward. While sitting at the table trying to work out which drugs the day team had put the patient on during their stay, and which had been stopped (harder than it should be!) I noticed one of the patients had a defibrillator attached to them. In my experience defibs are only usually attached when someone is having some form of cardiac arrest (or you are worried that they are) so seeing a patient lying still in bed hooked up to one of these really confused (and scared) me... I jogged over to the patient, and saw they were breathing  (good start) and looked asleep (to be expected as it was 5AM) so I asked the nurse why they had the defibrillator on them. Supposedly the day team had wanted cardiac monitoring for the patient, but the cardiac monitor that the ITU sent up didn't work - so they had just hooked up a defibrillator to use the tracing that it produces instead. I was confused (and a little concerned - what if someone changed the settings and accidentally shocked the patient). On the plus side, at least if the patient started getting more ill there would be no delay in initiating monitoring and treatment during resuscitation...

Like this, but the defib was manual so showed the heart tracing from between the pads

4 comments:

  1. I've done that. There was a weekend in FY1 where I had a patient who (a) needed cardiac monitoring, mostly because of the ungodly amount of calcium gluconate I was injecting into her, and HDU were persistently Not Interested, and (b) it didn't seem like a bad idea to have the arrest trolley in her room just in case, so I did just leave it there. It's harder to accidentally shock someone than you might think.

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  2. Your blog is really interesting! When I went on a medical placement, one of the FY2 doctors told us about his nights and said sometimes you hit a 'witching hour' where the gossip comes out (on a quiet evening of course!).

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  3. Oh nights! Glad you survived. How was it having the day to yourself?

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  4. Thanks for the comments.

    Beth - having had a bit of a shock at someone doing this, I have now moved wards and had to do this myself as well... Not ideal but I guess you have to do what you can with what you have!

    Kathryn - my nights seemed so busy there didn't seem to be time for gossip! But I make up for it during the day getting as much as possible ;)

    Peace - I slept most of the day, but the time off afterwards to recover (our annual leave) was so nice!

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