Night One... Check!

     I survived my first night of night float...and as far as I know, so did all of my patients!  All-in-all it wasn't too bad, thanks to the support and patience of the two upper level residents who were stuck with me I was working with.
     We got sign-out from the day teams at 5:30ish, and were able to eat some dinner before getting any calls.  Sign-out is where the teams caring for the patients on one shift tell the incoming shift all about why that patient is in the hospital and what the management plan is for them, they let the incoming shift know about any potential calls they might get about the patient/ any issues they are anticipating, and things they need to check up on (labs, etc.).
     One of the residents that I was working with last night typically brings in a homemade dinner when he's on call to share with the team - I've had his wife's cooking before and it is excellent, so I was super excited to learn that she had made one of my favorite meals....so delicious!  Also, since it was my birthday, one of my great friends baked me a nutella pound cake!  It was outstanding!
     Eventually it was time to get down to business, and we headed to the ED to admit a patient for chest pain.  I definitely felt a little rusty, and it can be hard to focus in the ED on a Friday night - it is SO noisy down there! - but overall the history and physical portion went OK.  Because of the noise level we headed upstairs to finish our notes.  I entered the entire set of orders with my senior resident's help - my first time using a computer order entry system - and those of you who know me and my track record with technology (computers in particular) will know what a miracle it was that the computer didn't burst into flames just for the mere fact that I was in the room!  I was able to find the right things to order, and customize them to what we needed, and get them signed without incident... but I later found out that this is not always the case (more on that later).
     I tackled another first last night as well - my first dictation of an admission history and physical - I think it went OK, but we'll wait and see how it turns out once it comes back from transcription!  That'll be the real test.
     Afterwards, we went around and took care of a few items on our to do list such as following-up on a patient's blood glucose reading after their dinner, and personally checking a patient's heart rate to make sure their beta blocker dose was sufficient.
     We then went back to the residents' lounge where I answered a few pages about questions on our patients from the nurses taking care of them.  One nurse called to say that one of our patients had a headache and wanted to know if she could give him some Tylenol.  I checked to make sure that he didn't have any conditions or medications that would make it unsafe to give him Tylenol, and double checked with my upper level to make sure she agreed (I know, I know, it's Tylenol for God's sake!) and then put in the order.  About 20 minutes later I got a call from the nurse again saying that I had put in an order for rectal Tylenol and was that what I really wanted?  Whoops - damn you computers, messing me up yet again (I suppose it's revenge for all the computers that haven't lasted longer than 2 years under my ownership).  Go ahead and laugh at me, I laughed at myself, and I'm sure all the nurses on that unit were (and probably still are) laughing at me too!
     Later on I evaluated a lady to see if she was in labor (she wasn't) and then sent her home.  Around 2:30 all three of us kind of hit a wall and decided to try and get some rest...that didn't last long.  We got a couple of pages about labs, and then around 3AM I got a 911 page from labor and delivery.  Nothing, and I mean nothing, will get your adrenaline running at 3AM like a 911 page from L+D.
     Last we knew there was no one in labor on L+D (our patient or otherwise), so we bolted upstairs to see what was going on.  A lady had come in in active labor, but was a patient at another health system so we had no information about her, and she didn't really know much herself other than that she had had several previous C-sections.  Not exactly a candidate for a vaginal delivery so we called in the on-call OB/GYN and I got to scrub in to be first-assist on my first emergency C-section.  There are a lot of details that I'm not at liberty to share on here in order to protect the privacy of the mom and the baby, but suffice it to say that if a patient could have a condition to make delivery high-risk for both mom and baby - this lady had them all.
     I am not ordinarily a fan of being in the OR, and scrubbing in on such an emergent case on my first night as an intern (and at 4:30 AM no less) definitely had me feeling the heat!  We got baby out, and I was so focused on my job at hand that I didn't even notice if it was a boy or girl!  It had been a long time since I'd seen a delivery of any sort - c-section or vaginal - and it was really amazing to be one of the first people in the world to see a brand new face for the first time, I had forgotten how cool that feels.
     By the time the surgery was completely over and we had finished up on labor and delivery, it was almost 6 AM, and time to sign out to the day team (sign out on weekend mornings is at 6 AM, and on week days it's at 6:30AM).  I was so exhausted at that point, I'm sure it's going to be hard to do that 5 nights in a row - but hopefully not all nights will have such a dramatic last half!
     I went home and took a shower, and forced myself to stay awake until the farmer's market opened at 8:00 and went and got myself a delicious banana and nutella crepe and a new hanging plant for my porch (the old one wasn't looking so hot).  I got home and gratefully collapsed into bed at 9AM, and didn't wake up again until 5:30.  It's definitely disorienting to flip my schedule completely around and become a night-owl.  Even now at 1:30 in the morning, my body is confused - my mind knows that I've only been up for 8 hours, but because it's dark outside (except for the lightning from the thunderstorm that keeps making my lights flicker) I feel like I should be in bed.  Also, since so much of my waking hours for this rotation are when most other people are asleep, there's not much for me to do except watch TV and read - kind of boring and isolating, but at least my gym is open 24 hours a day, 7 days a week (not that I'm going anywhere in this storm)!  I feel like things could go two ways on this rotation - either I'm going to gain a bunch of weight because I'm eating catch-as-catch-can and probably not going to go to the gym as often as I would  normally, or I'm going to lose a bunch of weight because without being on a normal meal schedule I'm only eating when I feel hungry, not because the clock tells me I should.
     I'll keep you posted on that, and on whatever else this rotation brings - the hospital can either be eerily quiet at night, or (like last night) completely insane!