Whew!

My last call for internal medicine wards was NOT one to forget. It's hard to believe all of the things that went on could really happen within one 30-hour period. Being able to actually use this stuff is much better learning than reading it in books and taking tests. Without further adieu, here is the list of major events (in addition to all of the high blood pressures, low blood sugars, and need for sleeping/pain pills) that took place on my farewell to Medicine Wards...

1. Pathology came back from the mole I took off in clinic last week. Positive for melanoma - skin cancer in a 29 year old. Negative margins, but my excision was 2-mm short of the goal. Arg!

2. Went to evaluate a patient for chest pain. That is nothing special, but while I was standing outside the room writing orders and a short note, her oxygen saturations dropped to 40%'s (normal is >90%). Thankfully, she improved with some suctioning.

3. A few doors down a patient went from being pleasant to acutely agitated and aggressive. She rips out her own IV. Obviously, I can't get any labs or studies. We calm her down with some Vitamin H (aka Haldol) in time for the nurses to note that she now has unilateral weakness. After a stat head CT scan to look for stroke, we finally get the rest of the studies I wanted originally.

4. Speaking of stroke... All morning I worked on getting a different patient calm enough to have an MRI for her stroke symptoms. We finally got a partial study before she freaked out in the scanner and a short time later the Radiologist called me: definite stroke. Next step, call the neurologist.

5. Beep... Beep... Beep... Code pager! They end up coding the same patient four times for V Tach.

6. Nothing exciting, but we did still have to do the standard admissions from the ER. One renal failure. One probable undiagnosed cancer. One delirious pneumonia.

7. Geriatric patient has passed away and needs to be pronounced. Sure enough. Time of death: 14:02.

8. Once again, called for a acute mental status change. On arrival, realize "nonresponsive" would be a better description. Stat labs/glucose/EKG please. Nurses are busy with that so I check blood pressure myself and it goes from 120s to 70s. Seriously!! Fluids wide open. Temperature now 34 - ask for a rectal - 34.6. Not normal! Another stat head CT once his BP is stable, and off to the ICU.

Think that's all. Guess again...

9. Someone else is throwing up blood. NG lavage gets back a lot more blood and of course now he's wretching with the maroon stained fluid oozing out of the sides of his mouth. Vitals and hemoglobin are stable. Another stat imaging study on its way.

10. What now? Another nonresponsive patient. Before I order my third stat head CT of the night we give a little Narcan to reverse the effects of narcotics. His eyes pop open and he glares at me. No more morphine for you, sir.

And to end the night, just as we start our morning rounds...

Beep... Beep... Beep. Code blue! I'm just down the hall so of course I'm the first doc to arrive. No pulse. Chest compressions going. Here we go. Get some meds going. Finally get an airway cleared of bloody vomit. After 20 minutes we have a rhythm, pulse and ICU bed ready across the hospital. Hold up, not so fast. A nurse two doors down starts yelling for help. You guessed it Code blue down the hall. Do you want to know how many crash carts are on the floor... one! That's not a good scenario when two patients are coding. Everyone rushed down there and supplies arrived from the floor below. Remember, the first patient is far from being stable and also now far from the ICU. Sure enough he goes asystole with only me, his nurse, and a respiratory therapist in the room. I start chest compression while ordering a round of epi again. Respiratory is bagging. The nurse is pushing meds. Other people are flipping from one room to the next to help out. We've almost maxed out our drugs and decide this will be our last round when we get a pulse. A good pulse. It was our window so we rushed him the 1/8-mile trek to the ICU. Prognosis is terrible, but at least he'll have a heart beat when family arrives to likely say their final good-bye's.

After all of that adrenaline I didn't even need my post-call Starbuck's. It was a relief to hand off the code pager to the next intern later that morning, but I was also incredibly grateful for the experience. I guess that is the way to end Medicine wards. You can't really top that!