First week back

1st day back from vacation and even though I've only been away from this place for 12 days, it feels like I have to re-learn everything. About an hour into work I look over to my good friend and neighbor for the night, MB and I say,

"Good Lord, I forgot how stressful our job is!"

"Welcome back!" she smiles.

My patient was a triple A repair (abdominal aortic aneurysm). I won't bore you with all the clinical details but basically the night got interesting and by 0330 I was banging on the on call room door to wake up the intern after 6 unreturned pages. I was not happy to say the least. My patient had signs and symptoms of internal bleeding. To make a long story short the problem was not managed well by our ICU team and when the vascular surgeons rounded in the AM they were not happy either. Especially when they came in and found out that their patient had a hematocrit of 16 (extremely low) and no one bothered to call them.


Sad thing is that I really liked the resident on call for that night and the intern himself isn't generally a nice guy but he's good... knows his stuff. I have a feeling that everyone's lack of response had something to do with it being their last night on the rotation. Everyone seemed to have an "I-don't-care-I'm-outta-here-soon" attitude.

Not fun.

***
2nd day back at work

I have a patient that I've had before... weeks ago. Unfortunately he took a turn for the worse and has been re-intubated (for the 4th time) and has been in a fierce battle with end-stage liver disease, as a result from years of drinking. Ended up eventually with esophageal varices and now, as I have him, has a severe lower GI bleed. We haven't been able to get his family here (whom he has been estranged with for the past decade) so he is still a full code, despite a very grim prognosis.

I ended up giving a total of 10 units FFP, 4 units RBC's, 2 of Cryo, and 3 of platelets. Practically cleared the blood bank out of everything they had. Came back from break at 5am and there is the GI attending scoping him and trying to find the source of his bleed.

"This must be punishment for taking vacation." I thought to myself as I step in the room and gown up to assist.

"Only 2 and a half hours left." MB reminds me as she passes my room, seeing the desperate look on my face.

***

3rd night back

His family arrives and he is placed on comfort care. He gets extubated and is put on a fentanyl drip. Now, here I am at 3am with a patient who has an O2 sat of 76% but for all intensive purposes is hanging on quite well. Trekking along at a HR of 80 and a blood pressure of 124/50... not bad for a man that is slowly bleeding to death.

Morbid? ... maybe, but its the reality of my job.

"Welcome back to the ICU dear"... vacation is definitely over.