Well, I'm glad I was half expecting some more "business" last night, because I sure got it, and it kept me up all night! I suppose this is more like what ICU call is usually like and I've just been spoiled up until now. Maybe God was easing me into things a bit on this rotation, and saving the really crazy times for when I had a bit more comfort and experience with ICU-level problems. Who knows? All I know is that right after the X-Ray finally came up we got a new patient up from ER who was so sick I spent the rest of the night pretty much at her bedside, and by the morning when the nurses came in for shift change, there were probably about 10 of us all around her bed doing various things. I'm happy to say she was quasi-stable by the time I left, thanks to the effort of the staff anaesthesiologist who came in to perform an extremely difficult intubation (which I knew would be difficult, so didn't even bother trying...you can get into a lot of trouble if things go wrong with an intubation - you lose the "A" part of the "ABC"s that anyone who has ever taken first aid or CPR will tell you about. And if you don't have an Airway, it's bad news!). He had a bunch of fancy gizmos that helped him do it successfully, and it certainly wasn't your nice slick intubation that you see on ER, but it did get done, finally. Then, among other things, what made things even more difficult was that this poor woman has some very complicated medical conditions that make her oxygen saturation levels on a good day around 80%. Normal is 100%, and we like to keep things at least above 92%. 80% is usually a call for something to be done immediately. Usually at that level the monitor is beeping at you very insistently, because most people really don't do well with levels like that. In fact, when we tried to reset the monitor so that it wouldn't beep with such low oxygen levels, it wouldn't let us. But this is her normal! She's always a bit blue around the lips, hands, and feet, too - again, just her. But imagine trying to decide whether what we're doing is working when she always looks the way most people look when we're frantically trying to get their oxygen levels up! Just one more challenge. And of course, everyone walking into the room who doesn't know the story is freaking out about the numbers on the screen.
Anyways, in all this I realized I was in over my head so called my staff ICU doctor in from home to come help, and we had another ICU resident helping, as well as the anaesthesia resident and the anaesthesia staff. And there were lots of nurses hovering around, as well as respiratory therapists. There's always help around! So with all of us putting our heads together, we got her through the night and she is, as I said, quasi-stable (meaning on a breathing machine, and on 3 different medications to keep her blood pressure from plummeting into her boots, but on the monitor, at least, she looks much better and noone is getting "stat" calls to the bedside, at least for now). Whew!
Fortunately, except for one other patient whose bed was right next to hers, everyone else in ICU did fine overnight and didn't require extra attention from me, and we didn't get any new patients in after that. So at least I wasn't trying to run around and do a pile of other things while all this was going on. Could have been much worse! I just kind of went back and forth between those 2 beds from about 2:00 onwards. I was very happy when 9:00 rolled around and my relief came in. I am back for more tomorrow, though, another 24 hours!
