Sinking Ship

Bailing out a sinking ship, with a spoon.

It is 3am.

I'm in the ER. I have 3 admissions in the ER. Patient #1 is intubated after acute decompensation having had a new heart attack. Patient #2 is in florid heart failure. Patient #3 is pregnant with twins (yay for being med-peds, I can handle twins and know some OB), and may have had, or be having a heart attack. I'm just opening the chart when the ER residents finds me to tell me about admission #4...

"Code Blue, Cardiac ICU."

Two thoughts:
1) You've got to be fucking kidding me.
2) Oh fuck, who is it now.

I run back to the Cardiac ICU, having left it 5 minutes previous.

Let me explain...

All hell broke loose about 1am. I knew I wouldn't sleep. Ms G was having unstable angina, and she was screwed. Would she go for cath? Would she go for emergent bypass? Forget the details, but the idea was to medically manage her overnight, and likely she would go for cath in the am, bypass in the pm. Except that I couldn't get her pain free when this all started for the 3rd time at 1am. And her EKG wouldn't normalize. Wicked ischemia. Likely infarcting as well. Oh, and now her blood pressure is down to the 70s. Hypotensive, 8/10 chest pain, EKG changes. Not a good combo.

And then they call Code #1 of the night. Adios Ms G... run off to another part of the hospital. Bring Code #1 into the CICU, the ICU resident (thankfully a med-peds colleague) is helping me stabilize her, getting in central lines. Now I have 2 very unstable patients, on opposite sides of the CICU. And I have 3 admission in the ER which have all come in since 1am.

So, there I am, running up the 2 flights of stairs, wondering which of my patients has coded. I have 2 likely candidates, but also there are 4 other patients who are on the suspect list. And much to my horror/surprise/relief, it's a cardiac surgery patient. That small sigh of relief is knowing that it isn't a patient I'm responsible for. And interestingly, the nurse (who is phenomenal) had kindly told me this guys story earlier on in the night. Which is immensely helpful since now I'm running the code and I already know his story.

3:45 am he is pronounced.

And the night just doesn't get any better...

Somehow, though, the morning comes.

9 admissions
2 codes
1 frazzled senior resident.