Thursday, December 1, 2011
Night of the living dead. Or, more accurately, night of the dead. Sorry this rotation is such a downer. Rapid response after rapid response. It's not until you run five codes in an eighteen-hour span that you realize, hey, these don't work all that often. If you're dead, unfortunately, you're probably going to stay that way. Realize that sounds glib. Don't mean it to. These were fortunately all end-stage patients, no brain activity, not people who anyone was expecting to be leaving the hospital. Doesn't make it better, but it does make it a little less tragic. 32 people in the room at one point, with me leading the code. I don't know what to tell 32 people to do. I barely know what to do myself. More than anything in residency, this was actually how it looks on TV. This was an episode of ER. A terrible episode of ER where no one lives and there really aren't any good guest star roles to cast at all. I'm screaming out orders, just trying to be heard over the commotion, people are grabbing drugs, people are doing chest compressions, it is chaos, it is intense, it is overwhelming. And it was dinner time-- three in a row, right at 6:00, we were running codes solid from 6 until after 9, so everyone was cranky, tired, had to go to the bathroom, hungry, everything. Unsustainable. If this rotation were longer than a month, unsustainable. I don't know how someone can be an overnight attending, a hospitalist, these jobs must be unfillable, I just don't know who could ever choose to do this. I want 15-minute blocks to my day, I don't want to carry five pagers, I don't want rapid responses. I want medication refill conversations. I know, I say that now, and then once I'm doing it, it'll be dull and horrible. But at least I won't be pronouncing people dead. Couldn't even read the clock by the end, just tired. Staring at it. Like, 7... 8... I don't even know. Why don't we have digital clocks in the hospital? We have all of this complicated equipment, and we can't have digital clocks?
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Sleep. Please get it soon. For your health's and sanity's sake, get some sleep!
ReplyDelete"These were fortunately all end-stage patients, no brain activity, not people who anyone was expecting to be leaving the hospital." - If these patients were end-stage, why on earth were they still candidates for resuscitation?
ReplyDeleteSD - Resusitation is always done, unless there's a DNR request on file.
ReplyDeleteJessa - What I'm really getting at is why there wasn't a DNR request on file. At my institution, we're trained to talk to all patients about code status, particularly those with end-stage conditions. It's very rare to run a code on someone with an end-stage disease, except in cases where the patient has been recently admitted to hospital and either the discussion about code status hasn't happened or the patient hasn't come to grips with the diagnosis yet.
ReplyDeleteRe: digital clocks - one of our intensivists uses his iphone timer during codes (for 2 min cycles of CPR, etc). I think it's a good idea. I also wonder if he has his ACLS algorhythms on there.
ReplyDeleteAlso, 32 people in a code is way too many and becomes unsafe when it leads to poor communication. Part of my role as charge RN is to kick out the people who are not actively needed - besides, they should be watching the other patients. There is rarely reason for more than 10 people in a code room - and that's pushing it.
Well, I work at night and go on all the codes and I agree you don't need all those people. What's needed are: two nurses (one to push meds and the other to record), two resp therapists (one to bag and one to do compressions, and one doctor who doesn't act like he/she's doing you a favor by showing up.
ReplyDeleteSorry. But I get a bit tired of doctors complaining about working at night. If you don't want to work off hours or be called in the middle of the night, please do us all a favor and go into law or finance. Otherwise, keep the attitude to yourself.
As far as the clocks are concerned, you need a clock with a second hand so that, should the machines fail, such as the pulse oximeter, you can still take a manual pulse and get a resp. rate when assessing the pt.
Sorry. I'm a bit miffed. I've worked at night with too many doctors who are more interested in sleeping than doing their jobs.
Sure you went on a few codes, but most doctors have no idea what the support staff does at night and how more often they'd be called if we didn't.
So, do us a favor, next time you come into a room, don't tell us how tired you are. We're all tired! Just do your job!