the straw that broke the sleepy resident's back

i have now completed 2 of 7 calls, and have 19 days left of ccu. hooray! in all honesty, i don't mind the ccu, i actually like, as i mentioned before. but i still dislike being on call, and my experience last night reminded my why--it was without a doubt the worst night i have had as a resident at my new program. in fact, i had flashbacks to my many unhappy calls as a surgical intern; ugh.

why was it so awful? it wasn't the new patients, since there were only 2, and they were straight-forward heart attacks; not much going on there. what really got me was the never-ending stream of completely inane questions and information i got from the nurses. literally, i was paged every 15 min from 1am until 6am. this is not an exaggeration either. and there was not a single incident that required me to see a sick patient; it was all garbage that did not require attention in the middle of the night. my favorite was a nurse who informed me that a unit of red blood cells that i had ordered for a patient at 245pm had not been given. it was now 345am; did i still want that transfusion? this sounds like a joke, but it is the truth, this is how medicine works.

i was barely able to contain my anger at this point--i asked the nurse, after a useless attempt on my part to figure out why this had happened, if she really thought that she needed to call me at 3am to ask me this question. she told me she didn't understand the question. so i rephrased, and inquired under what circumstances she imagined i might tell her that the blood was not necessary (presumably she knew that patient and why there was blood ordered--she was bleeding. not a massive hemorrhage, but loosing blood). she sputtered out some gibberish, obviously not sure what was happening. at this point i felt a little guilty for being terse with her, so i relented a bit and asked her what she needed from me--another order for the blood? clarification as to why we had ordered it? maybe she thought i was patronizing her because at this point she snapped at me informed me she knew the patient was bleeding (slowly) and in fact had just been with the patient who had informed her that she (the patient) was still bleeding, not 5 minutes prior to our conversation.

she did not relay this information in a friendly manner. at that point, i lost control. here is a summary of what came out of my mouth next, although admittedly my memory may have been clouded by my intense rage: so you are telling me that there was an order for a blood transfusion for a patient who was bleeding that was entered 12 hours ago but that was never given. and now you are calling me at 3am to ask me if you still should give it, when not 5 minutes ago you with with the patient who informed you that she was still actively bleeding? this is not the type of order that can be "overlooked" and is certainly not something that needs to verified after it has been forgotten. this was all conveyed at a very high volume.

once my rage was unleashed, it was hard to contain. i did the best i could for the next 2 hours, and had moderate success. once the other teams had arrived for the day, around 6am, i thought i would be unburdened, since most of the calls had been on their patients. oh how wrong i was. i got called around 630am and was told that a patient did not have any orders written for morning labs; the blood had been drawn, but there were no labels for the tubes so they couldn't be sent to the lab. she asked if i would enter the orders. normally i would be happy to, i informed her, but i was dealing with an active issue with one of my own patients and furthermore, the primary team was there son they could decide what they wanted. she asked me if i knew who the intern was. i told her it was either intern x, or y (i gave the last names). she asked if i know their pager numbers, which i did not. she then, in a rather snide manner, asked me how she was supposed to track down the proper person. i replied that i was sure that this wasn't her first day and that i was confident there were ways she could obtain the required information--for example, the blue sheets of paper taped-up at every nurses station that list the names and pagers of all the residents currently working in the ccu.

she then told me "nevermind...it's not that important. we just won't send any labs." my anger went to 11. i said (actually, i screamed; i was so angry that i was shaking) there is a solution, which is to call the physician who is taking care of that patient and find out what needs to be done. the solution is not to call the first person who's pager you have and then imply that you won't follow through if that person won't track down the responsible doctor; that is both irresponsible and negligent. you need to do your job, which is to discuss this issue with primary resident. i waited for about 5 seconds, during which time there was only silence, and then i hung up.

i felt another twinge of guilt and was about to enter the orders myself, when my pager went off again--fortunately this time it was about one of my patients, so off to work i went.

i'm sure this will all come back to haunt me, but this was one of the rare times when i completely lost my temper. i will try to do better next time.