After a week of night float, I'm in full survival mode. The key is getting a decent sign out, following up on basis labs, answering the relentless pages, putting out fires, and praying for everything to get done for the 60 patients you have to manage for 14 hours. I don't think it gets much more brutal than this (I could be wrong, of course).
The first night was especially memorable, as it was my first time on the Hahnemann floors. I didn't even know where sign-out was, which was a bad sign. I got slammed with signouts and nursing calls. On top of that, I had a sick patient, which I didn't know what to do. For one thing, the patients are much sicker at Hahnemann; everyone is end-stage kidney/heart/liver disease. They're all one step away from disaster. Not exactly the kind of knowledge that makes you feel comfortable. I was scared of the pager, the patients, and everything around me. I don't know how, but by day 4, I was figuring things out and actually felt a little bit in control.
They say intern year is the toughest. The responsibilities change dramatically, but you're knowledge is still that of a fourth year med student. It's an abrupt wake-up call. At this point, you're not trying to swim, just treading to stay above water.
My fire last night was a girl with a very high potassium. The issue is that you can get a lethal heart arrhythmia without treatment. I didn't find her in her room. I talked to the nurse who told me she was visiting someone on another floor. So I went down and asked the nurses there, but no one had seen her. I even paged her on the overhead speaker. The whole time she was outside smoking and hanging out for 2 hours. In the end, she only got half the treatment she needed, but it was enough to hold her over until the morning.
Only 3 more weeks of this craziness.
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