The weekend wasn’t quite as bad as expected. Enough sick patients and enough traumas can get even the slowest of attendings to start moving, and I like this attending better at midnight, arguing with helicopter command about the tenth ridiculous trauma alert of the evening and struggling to keep the seven car accidents and six motorcycle accidents straight, than during morning rounds.
On the other hand, I had trouble with lines again. I got some good a-lines in, hurrying before rounds started. (I’m afraid I drive the ICU nurses crazy. I show up right after shift change and insist on putting in lines or changing wound dressings, right then. My only excuse is if I don’t do it then, it won’t happen. I didn’t stop moving for 30 hours this weekend, and lots of small things didn’t happen, because there wasn’t time.) But for the rest of the day, all the central lines I tried didn’t work. There were good reasons, but I expect I’m making the seniors who were forced to come help rather nervous about my performance next month. Ah well, let them be; I’m nervous too.
We saved a guy’s life (intubated, lines, the works), and he woke up the next morning to yell at us about some chronic pain issue that had nothing to do with his arrest. When someone’s arresting, you have no idea what kind of person they are; but I’ve found so far that the more dramatically you save someone’s life, the more likely they are to be a nasty personality who won’t ever realize what happened, or even say thank you for taking care of me, let alone, for saving my life.
It’s long been an ambition of mine to calculate some real live TPN. Sadly, although this is a traditional and important part of the surgeon’s trade (being able to provide total parenteral nutrition for someone you’ve operated on), at my hospital it tends to be taken over by the pharmacists or by a physician who specializes in nutrition, because the surgery attendings have no interest in managing outpatient TPN. But in the trauma ICU, we take care of all critical care issues for our patients, including doing the TPN at least through the pharmacists on our team. Sunday, no special pharmacists, and the attending said to start TPN now. So, after 30 hours of being up, I tried my hand at TPN calculations. They’re not that complicated, if you can just keep your eyes open. The weekend pharmacist seemed to think they were reasonable, so we’ll see tomorrow how it worked.