post call addendum:

22 days to go.

it's now post call day number 1 for me. i have to admit that last night wasn't too bad. only 2 new patients, although one of them did come at 3am, right in at the height of the time i could have been sleeping. i was not so excited when my pager went off and i called back to find that there was a new patient. ugh, i thought, there goes any chance for sleep. thus, when i was laying down at 408am, hopeful that i'd get a few hours of sleep, i was both surprised and gladdened.

how did this happen? how can a patient get admitted in just over an hour? well, i'm going to tell you. in the ccu, things run somewhat different from other intensive care units, as i discovered. many patients who come to the ccu have had heart attacks, and many of these people go to the cath lab prior to coming to the unit (that is the place where angioplasty is done and stents are placed).

this particular gentleman also had an intra-aortic balloon pump placed:






this all sounds very complicated, and in some ways it is, but the end result is that most of these patients arrive with their definitive treatment already carried out; furthermore, there are numerous studies which have looked at the best way to treat these patients for optimal survival. therefore, there is not much thinking and decision making that needs to be done when they arrive--in essence, they come pre=packaged. this isn't to say that there is no value in this experience for me, because there is, as i need to learn what is done to these patients and why, but it is easier to deal with these patients when they arrive because you are not spending time trying to figure out what is wrong, rather, you are treating them.

this is how it differs from other areas in medicine, and particularly the medical icu, where patients are essentially train wrecks who arrive with many problems, nearly dead, requiring copious time and energy to figure out what is actually going on--which is what takes the most time--before they can be treated.

in addition, since there were only 2 new patients, i actually had time to read about their conditions and our treatments so that on morning rounds i actually felt like i could speak intelligently about what was going on.

so as much as i can't believe i am saying this, i actually enjoyed myself!

day 6 beings in just 10.5 short hours; time for sleep.