I’m not going to say how many hours I worked in the last four days, in case the ACGME ever finds this blog. Let’s just say neither I, nor the other residents involved in the holiday weekend, plan to let anyone know officially how much time we spent in the hospital. Our program is good to us as a matter of course, and we have no intention of letting the cracks show.
I saw half a dozen unique cases; not just zebras, but orynxes and wildebeests – legendary diagnoses that even the attendings who diagnosed them had never seen before. My patients got such continuity of care, it was unbelievable; they started asking if I actually have a house, or just live in the hospital. I got to see cases, the postop course, the complications, the treatment of the complications, the result of that treatment. I wouldn’t have wanted to miss that, just for a few more hours of sleep.
I’m also wildly excited because I got to do three central lines in the last two days. The last one I did without anyone watching, because we were too busy, on an immensely obese man, heavily anticoagulated, with such bad access that no one could actually tell me what his coags were, except high. He needed dialysis, and was short of breath sitting up, let alone when I tried to get him to lie flat so I could do the line. He was on a dismal medicine floor, with a nurse who looked nearly as scared about trying to do the procedure as the patient was. I questioned my judgment in trying to pursue the line, but went ahead for two reasons: he really desperately needed dialysis access (which meant it would have to be a gigantic catheter; which meant if I messed up, there would be massive bleeding) and there were no other options at that time of day, and medicine had asked us for help. Two very good reasons to play cowboy. I dived in, and between sweet-talking the patient into lying still a little longer while I poked needles into him (he was too huge for the lidocaine to cover anywhere near the territory involved) and walking the nurse through opening various kits for me, I managed to get the line in. Just as I was catching my breath, not quite believing it was in, the chief walked in to check on me. His eyes went a little wide when he saw what I’d tackled, and accomplished, but he just said, “Good job.”
So I’m psyched. I took a risk, and it paid off; I made a judgment call, and it worked. I can actually do tough procedures on my own. The nurse thought I was being calm. Maybe I’ll be a surgeon some day.