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04 December 2008

60 Hours

When I started my emergency medicine residency, I was told that all of our shifts are 12 hours long. Coming from a surgery residency where shifts can be 30 hours long, I was looking forward to the break. Having just spent the last five nights working a series of 12 hours shifts, I have realized that the hours add up pretty quickly.

While I can't write about everything that happened over the last 60 hours, I can hit the highlights. I have also found that the more tired I am, the more surly I become with patients. After a brief 18 hours to adjust from night shift to day shift, I was back at work this morning. My body was telling me that it was nighttime and I should be sleeping. Caffeine does wonders for the sleepy mind.

Anyway, what do I remember most about my last block of shifts:

- even pretty teenage girls from good families can be more troubled than you would think. I sewed up a 5 inch cut across her arm where she was "cutting" to hurt herself. It matched a series of other cuts that she had already put on her arm. This one was deeper than those, and I had to sew the wound closed in several layers and oversew a blood vessel that she had cut as well. Off to psych services, and probably alcohol rehab. She'd already lived more in 15 years than I had at 3o.

- the legend that people are more depressed around the holidays never showed more true than in this weekend after Thanksgiving. Our board shows the 20 rooms in the E.D. At least once per shift this weekend, there were 8 - 10 OD's, SIWL (self inflicted or suicidal ideation with laceration), rehab, depression, alcohol withdrawal, AMS (altered mental status), etc. on the board. It got so bad that I said that if I had to see one more suicidal patient or OD I was going to commit suicide. My senior actually called over to psych services to see if I could be committed for making a suicidal intent statement. They said yes, and that they would be more than happy to send security over to restrain me for a while. All in jest, but really... I was going crazy.

- there was a sale on car wrecks. Crash yours into someone else's and you both get seen for free!

- we had the first snowmobile accident of the year. No snow on the ground, he'd just had it tuned and wanted to hear it run... and it did, right into the building then flipped over on him. He had no injuries, luckily. We'll see how the rest of the season goes.

- for some reason, more stabbings are happening than shootings. They're a little hairier because you don't know just how far down the blade went. Bullets you worry about the path. Knives you're dealing with too many variables. We CT scan everyone. Oh, and marijuana is considered by some to be medicinal for post-traumatic stress following having been stabbed by your best friend who was high on "some pills" and thought you were suddenly out to get him. It's not.

- some attendings I get, some I just don't. Wonder what kind of attending I will be?

- even big strong 36 year olds die. Suddenly. We had one with a massive pulmonary embolism that died around 3 in the morning several nights ago. We worked hard to bring him back. Nothing would work. It affects the whole staff when something like that happens. Of course, I also had the 38 year old with end stage AIDS whose mother signed the "comfort measures" paperwork and then wouldn't let go of them. We all knew it was in the patient's best interest. I can't even begin to imagine the feeling of signing a paper that will limit the care your child receives. No matter the age, they are always your baby.

- which makes me salute all the mothers who brought their child to the ED for help and sat by their side while I explained what happens when you OD on soma, lortabs, alcohol, antidepressants; or while I sewed self-inflicted lac after lac; or who encouraged them to get help from Abuse Intervention Services because they "couldn't take it any more."

OK, it's late and I have one more shift before getting some time off... be happy! My ED patients have been so depressing lately.


a corgi said...

oh my gosh, Veronica, what a nightmare time, not only for you and the ED staff, but the patients; that is soooo sad, especially the young kids with the depressive problems

I just saw a report on the news this past week that they were reevaluating whether 30-hour shifts were good for interns; they knew the importance of sleep; just didn't know impact on patient care/continuity of care. 12-hour shifts would be hard too; you don't know whether you are coming or going sometime. don't know how you do it

I think you'll make a good attending

its 70 degrees, sunny here in So. Calif today; thought you might want a weather update :)


Julie said...

Those type of long shifts are inhuman and I hear you one the depressed patients, darn right depressing it is to work this time of year I tell ya. Hang in there.

D said...

get some rest.. those are tough hours

Claudia's thoughts said...

People look forward to the holidays, there is so much happy expectations. When it doesn't occur people are really let down. I can understand how someone will feel that way.

Who knows what things go on it peoples brains....there is an expressions for someone who is older than their stated age" "Rode hard and put away wet." Refering to horses not taken care of. A lot of miles around the track of life. But, really, being in health care. I came to the conclusion that about 95% of the problems in peoples are caused by themselves and their bad choices. If it weren't for human stupidity we would be unemployed. Some people learn and some never do..

miss alaineus said...

i think that the media really contributes into the depressive issues you spoke of, as they create a fantasty world which people think is obtainable, and then cant handle the let down of reality.

i also think doctors should have to log their hours (almost like truck drivers do) for their own health and for the health and safety of their patients. i know how i get when i am slap happy tired ass draggin and i cant imagine feeling like that and having to make decisions with outcomes that could have life altering consequences.

always love to read your blog when i get a chance.


Jeanie said...

Dear Veronica,

I'm not surprised you were feeling surly after doing all of those hours! How sad that you just see the end result of those troubled minds. I wish there were ways to help such people before they get so depressed. Bless them!
I'm not surprised it gets to you in the end. You wouldn't be normal. After all you are in a profession where you aim to help people get well but when they self inflict it must be so frustrating to watch them come in time after time to be 'patched up' again, with their problems still hanging over them like a cawl.
I hope you get out and about for a change of scenery and fresh air.
Enjoy recharging your batteries.
Jeanie xx

Jeanie said...

Hello Veronica,

I just popped in for another visit. I hope all is well with you and that you are not working too hard.
Thinking of you.
Jeanie xxxxxx

fawn said...

Every time I read your blog and you refer to "ED patients", for a split second I think Erectile Dysfunction... thanks Bob Dole. The ED patients are lucky to have you Veronica. I don't think I could find even half the compassion you have.

erarein63 said...

Ah yes, the holidays, aren't they uplifting? We get this a lot too. Makes you just want to go home and hung your family a little bit tighter doesn't it? De ;)