Sunday, June 05, 2005

When to Ask

The patient arrived from the E.R at about 5 p.m. Not a very healthy specimen, really. First heart attack before age 30 years, poorly managed diabetes, hypertension basically ignored, obesity, and still a smoker even after cardiac catheterizations that resulted in the stenting of a couple/few coronary arteries. Nothing much wrong with them aside from that.

We ran into some blood sugar problems, like levels in the 500 range, but basically OK for the couple hours I spent with them before my shift ended.

Later I thought that maybe it would have been cool if the ER nurse who gave me the patient had mentioned that the patient's sugars were just a little high.

Something else just didn't seem right to me, though I couldn't articulate anything specific. I spoke to the attending doc and a couple residents, saying "I don't think this patient will end up staying the whole night here," and they agreed, but there was no reason yet to make a move.

The cardiologist wanted to take the patient to the cath lab that night. Odd, that.

Next thing you know, the oncoming nightshift nurse was getting a crappy blood pressure, like 60 over just about nothing, and the pace picked up a little. Dopamine and another pressor were started, a couple cath lab nurses showed up, and the cardiologist stuck a central line in the patient's groin.

The doctor didn't even gown up. He just tucked his tie into his shirt, and somehow he didn't get a spot of blood on him. Classy, that.

Soon it was 9 p.m. I was tired after 14 hours of work and I wanted to go home. There were about 11 other people in with the patient anyways, and it looked like I was done. They intubated the patient. I phoned the family, but they still hadn't arrived by the time the patient left the floor for the cath lab.

One of the cath lab nurses had borrowed my stethoscope, and I didn't really want to interrupt her at the bedside to get it back. It just wasn't the right time to ask. She put it on the patient's bed as we wheeled them out of the room and into the hallway, so that's when I grabbed it, at 10 p.m.

If I had left before that, my stethoscope would surely have disappeared and I'd never have gotten it back again. And those things go for big bucks these days.

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