Things are going pretty well. I'm post-call today, so I took a nice 6-hour nap. On call, besides being responsible for my team's GI/oncology patients, I have to cover two other teams' patients: colorectal surgery and vascular surgery. Normally, the vascular patients are the sickest ones and are the reason behind 90% of nursing pages in the middle of the night. I surprisingly only got two pages about vascular patients last night, though.

The (usually benign) colorectal service had a bunch of bombs that kept me up until 1 a.m. One patient's sodium was rapidly falling (from 138 to 122), so I had to transfer him to the step-down unit (a higher care unit in the hospital for patients too sick to be on the wards but not sick enough to go to the ICU) because of the risk of seizure/cerebral edema with hyponatremia. I did a post-op check on a patient with Lynch syndrome s/p colectomy, and she complained of feeling "restless," which can be an early sign of respiratory distress. I drew an ABG and, lo and behold, she was hypoxic, so I had to deal with that. And my own team's patient (s/p thyroidectomy) has been in afib since the surgery and is not responding to rate control mechanisms (maximal doses of metoprolol, digoxin, and even a diltiazem drip), so we needed to cardiovert her. Busy night! Overall, though, despite the hours, this rotation is not too bad. It's actually growing on me. Trauma was way more stressful. Also, for some reason, my team is getting a third intern tomorrow, so that will help to decrease the work load.

One closing thought ... I am dying to see the This Is It movie. Maybe this weekend.

Time flies by ... I just have one overnight trauma surgery call left. Call on Monday wasn't too bad. One of my team's patients admitted for alcoholic pancreatitis went into florid DTs (delirium tremens), despite being written for Ativan BID prophylactically. His BP went up to 210, his pulse was 185, and he was standing on his hospital bed shouting and being very combative. It took 6 mg of Ativan and four people to get him into 4 point restraints. I also got called about a leaking wound vac on a 500-lb patient with Fournier's gangrene s/p debridement. I ended up having to change the wound vac (which continued to leak after being changed because of all of the crevices in the groin area). It was so nasty.

I'm ready to move on to my next rotation. Trauma surgery is insanely busy. I'm okay with waking up early to go to work (4:30-ish in the morning), but I HATE staying in the hospital until 8 or 9 p.m. on non-call days. (I know, I know ... whine, whine, whine.) Basically, we add anywhere from 15 to 30 patients to our service every call night (q3), so things can rapidly get out of hand if I'm not efficient at discharging patients. I really enjoy getting to do all of the prelim reads of the CT scans that most trauma patients get; it makes this rotation more relevant to my future specialty!

I switch to another surgical service next week (GI/oncology). It HAS to be better than trauma --- I'm hoping that I at least have time to eat/drink/pee during the day!

I took my final psych ER call last night, and it was extremely busy. Since it's the weekend, there is no attending in-house and that makes it more difficult to discharge patients (it requires calling the attending over the phone to discuss the case). I had probably 15-20 new patients between yesterday morning and this morning, which might not sound too bad, but between physically interviewing/examining the patients, contacting their families for collateral information, writing admission orders, and being paged by the psych ward, it felt like a ton of work. Out of all of the patients, only two were voluntary --- the rest were on a 5150 (involuntary 72-hour hold).

We had to call a code green on one of the patients who was getting out of control. He was very agitated and was hallucinating that all of the staff members were trying to kill him. He pulled his mattress off the bed frame and was holding it perpendicular to the floor, using it as a shield of sorts. Then, he somehow got ahold of a plastic knife (probably one of his dinner utensils) and lunged at one of the male nurses. He made a huge cut down the nurse's arm, from the antecubital fossa region down to the distal forearm. I think the nurse had to go to the medical ER for sutures. The other nurses were finally able to get the patient in four-point restraints and give him IM meds. Code greens are pretty common in the psych ER, but this was the first time I'd seen a staff member get injured.

My final day in the psych ER is Wednesday, and then I'll start four weeks of trauma surgery. I'm pretty nervous about it --- it will be my first ward month of internship and I know the hours will be brutal. One of my co-interns doing trauma surgery right now said that sometimes he stays until 1:30 a.m. on non-call days. I guess the census can get out of hand because he sometimes has 50 patients to manage. Ugh. I'll live ... right? At least I'll learn a lot during the rotation and will hopefully become more efficient with time.