Tuesday, November 20, 2007

scenes from my friday night on call

This past Friday, I was on call for Pediatrics, my last call of the rotation. (But never fear, children of New York! I will be back on the Peds service over Christmas and New Year's! Just what you asked Santa for, I'm sure.) Because I was on call that night, I spent the day rounding with the Peds Pain team, and we were making one last pass through the ICU before I was to head back down to the ORs. The new wing of the ICU, where we were, has floor to ceiling windows, facing South.

Look at that. That's a gorgeous view.

Absolutely beautiful.

I kind of want to take a picture of it.


I have a camera on my phone.

You should do it.

This'll just take a second.

(Taking out his Treo)
I'm going to take a picture too.

(We stand there for a few seconds taking pictures.)

OK, lets get out of here before they think we're crazy.

I don't mind if they think we're crazy. I just want to get out of here
before they start asking us to do more consults.

Back in the OR, having finished up an ortho case, I began setting up for a liver transplant, which I was told would start at 10pm that night. I was not thrilled with the idea of staying up all night, but I like challenging cases, and I haven't done a liver in a kid yet, so that part at least would be fun. Now, one thing that may surprise you about me (brace yourselves) is--I'm kind of anal. Especially about my setup in the OR. My desk at home looks like a bomb hit it, and all the clothes that Cal has outgrown are heaped up into garbage bags, awaiting sorting, but when it comes to a meticulous setup, I am king of the sphincters.

It's a disease.

I went upstairs to pre-op the kid (she was sitting up in the ICU with her parents, awaiting further instructions from our transplant team), and, walking out into the hallway, I heard one of the Pediatric Surgery fellows with his assembled entourage talking about a kid in the ER. I overheard the words "vomiting" and "acidotic" and "possible ex lap," (that is to say, an exploratory laparotomy) and figured that this might at some point in the night come to concern me.

"Sorry," I broke in during a pause, "is there a kid you're going to ex lap tonight?"

"Possibly," the fellow shrugged. "Depends on what the scan shows."

"OK, I'm just checking. Because we're going to be starting a liver in a few hours, so..."

The fellow shook his head. "Not my problem."

I try again. "Well, what I mean is, if I'm in the liver, and you want to start this other case, I'm going to need to call some backup."

He didn't want to hear it. "Not my problem. Nursing has a separate team. Doesn't matter."

"Well, I guess, but you're going to need a separate anesthesia team too. We only have one Peds anesthesia person on overnight. If we're running two concurrent cases, I'm going to have to pull someone from the adult side. I'm going to need to know in advance."

"Not my problem," he said again. I just told him to let me know as soon as he figured out whether or not the case was going to go, and then walked away. Let's see it "not be your problem" when you're trying to do this case without an anesthesiologist, I thought to myself, but of course, not being an antagonistic person, I didn't say this out loud. (This is also called, "being a wuss.")

The OR front desk called me to let me know that the start time for the liver had been pushed back to midnight, and there were no cases booked until then, I figured it was safe to walk out of the building to get some dinner. On my way back, I stopped by the new Starbucks and got a large (oh, sorry, "Venti") latte, figuring I could use the caffeine. What I had neglected to note was that Starbucks coffee has roughly twice the caffeine content of regular coffee, so after finishing that cup, I was really, really, really awake. Just in time for the front desk to give me another update: the liver had been pushed back again, this time to 7:00am.

Well, it looked now like the transplant wasn't going to start on my watch, but given the uncertain nature of other cases being booked (the Peds Surg fellow had also mentioned in passing that the ER downstairs was absolutely packed), I didn't feel like it would be a good idea to go home and risk getting paged back. Luckily, anticipating such a holding pattern scenario, I had brought my laptop into work that day. So I went back to my call room, fired the thing up, and did some writing for a few hours.

By 2:30am, I still hadn't heard anything, but still didn't feel safe going home, so I lay down and slept fitfully for about an hour and a half. (The mattress in the call room is made of drywall, I believe.) By four, I wandered back out to the OR area. No one to be seen. The lights were off at the front desk. I weighed my options. I went back into the OR where the liver transplant was scheduled to go later that morning and made sure everything was all set up and ready. And then I jumped into a cab and headed home. I was in my own bed by 5:00am.

So even though there hadn't been a case in the OR since about 8:00pm or a page on the Pain pager since 9:00pm, I ended up pretty much spending the night in the hospital anyway, despite being on "home call." I played the odds, gambled, and lost. I'm no good at this kind of thing.


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