A Medical Intern’s Overnight Call

From EGO:

Med_intern_april_main1 It was about 12am during my Saturday overnight call–the worst night to be on-call. Despite the obvious loss of the weekend, it was also the “night float” interns’ night off, which means four of us held down the fort for the other interns’ patients, while we admitted new ones. I had six patients I was already caring for, some of their problems were clear cut and being treated, others I was clueless about. I had one 40 year old patient in fulminant liver failure. Liver cancer? Infection? Some autoimmune or inflammatory disease? The etiology remained unknown, but fluid was accumulating in his abdomen (ascites) and lungs (pulmonary edema), and now his kidneys were beginning to fail. He was in severe respiratory distress on the brink of being intubated, and all we could do is cross our fingers and await the biopsy while we pumped him full of antibiotics to cover any sort of infection.

My second sick patient was an IV drug abuser with sepsis, who likely had endocarditis–bacteria growing his blood and seeding into the valves of his heart–causing symptoms of a failing heart. His vital signs were barely stable as we tried to control his infection with broad spectrum antibiotics and intravenous fluid support. I had four other patients with everything from an HIV patient with a fungal pneumonia, to an 80 year old man who thought it was 1975 and swore he talked to dead people last night. Such was the scene on a busy night during my first month on the medicine wards as an intern.

Sleep deprived, and overwhelmed with the workload, I felt like I would never sit down, never eat, and my pager would never stop beeping.

More here.