We started off the night with another central line, which went pretty smoothly, all things considered. Brad was willing to try a different approach that we hadn’t done before, which made things slightly more tricky, but it went in the right place.

Some time later, I got called by one of the medicine attendings: “Your patient just had a code purple [substitution for hospital’s pet phrase for not quite a code, but deserves an emergency response team] called on them for unresponsiveness, I’m up here, and my resident is determining whether they need to be moved to the unit.” There goes one of my nightmares come to life: my patient crashing, and I didn’t know about it. I ran upstairs after paging Brad. Things were under control, and probably could have been handled without all that commotion, except that the operator whom the nurses had told to page me stat, ten minutes earlier, had somehow decided not to, and everyone had assumed that when the code purple was called, I would know about it. Which I don’t; surgery pagers are busy enough with real code blues and trauma alerts; we can’t pay attention to every code purple, which is usually a plain medicine problem. Bother. “The medicine resident will decide if the patient needs to be in the ICU”; thank you very much, she’ll be fine right here on the floor, with me checking on her every half hour all night, now that I know about her. (And she was.)

So there I was on the floor, cleaning up odds and ends, when another nurse came up: “Alice, did you know this guy in 765 has a pretty high fever?” “Sure, give him some tylenol. And do you know the rest of his vital signs?” “Well, he’s pretty tachycardic, almost 120.” Now I’m interested. We got an EKG. Somebody ought to list fever as one of the presenting signs of heart attacks in the textbooks. . . One of the nurses, who has a big chip on her shoulder, and antagonizes most of the residents, but for some reason likes me, took over for that patient’s nurse, who seemed remarkably uninterested in her hypoxic, tachycardic, febrile patient, and procured all the equipment for a nonrebreather face mask, continuous pulse ox, and other paraphernalia. I felt a strong temptation to call my own code purple just to make the Xray and lab people come up faster, but the guy was so remarkably comfortable in spite of everything that I decided not to be histrionic.

From now on everyone with a heart rate over 110 is getting an EKG. I don’t care how good of a reason there seems to be for them to have tachycardia. EKGs for all!

A very educational night overall, and reassuring that I’m learning to handle some emergencies pretty decently. That fairly outweighs my defeat for the night, when I let a temperamental and manipulative patient talk me into completely reversing her npo status (after she bugged the nurse so much that she paged me every five minutes for half an hour).

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