My biggest fear is for the code pager to go off while I am in the restroom.
It did go off angrily followed by the overhead PA system announcement the code location. The unit to which I was instructed was located a hike away from where I was standing watch, but it's all hands on deck at nights. By the time I get there, running overpasses across the hospital and climbing stairs avoiding slow elevators, the code team localized to that section of the hospital is firmly in control. Anesthesia team is intubating, intensive care unit crew is assessing and making the transfer arrangements. Seeing the order coming out of chaos, I sign off and head back to my tower. One of the intesivists wishes me a good night, "See you at the next code," he says.
Back to my hematology unit, where I am watching over thirty-four patients trusted to me by the day teams, my spectralink house phone goes off incessantly.
"Ms. B. has a fever of 100.8. She _is_ neutropenic; do you want to culture her and start antibiotics?" "Sure, I'll put the orders."
"Ms. M's platelets are 4."
"Yes, I know. I need to speak with the blood bank since she needs special platelets. Is she bleeding anywhere?"
"Ms. L.'s heart rate is 150, and blood pressure in the low hundreds."
"Please do an ECG, and I will be right there."
"Mr. F. has a temp of 103, his rigoring and breathing at 30. He is going to hospice tomorrow morning. What would you want to do, doctor?"
"I will be right there"
"Ms. C. has soft blood pressures, heart rate in 120, and she has not had made urine since the beginning of the shift"
"Give her a liter of normal saline bolus. I will be right there."
"Hi, is this heme service?"
"Yes."
"You have an admission from the emergency room. He just arrived on the floor."
"Oh. What is he here for?"
"I will be right there..."
I look at my spectralink that says "Bloody Mess" where it should be "Hello, World." The code on my floor is just a matter of time. No time for a restroom break.
Code pager goes off again. _Not_ my floor. Where? East Pavilion. Stairs down, bridges, stairs up. Running through the mental checklist of what to do when I get there. Same intensivist joins me on the run, "Get me there the shortest way." "No problem boss, hang on to your badge."
The day team starts to trickle in. Interns first. Early. Hair is still wet. Time to sign out the service back to day teams.
"OK, so Ms. M. got her matched platelets. She is fine."
"Ms. B. had a small temp, cultures sent, broad-spectrum antibiotics. She is fine."
"Ms. L. was in atrial fibrillation, there were no telemetry beds, so I managed her on the floor. She converted back to sinus. Blood pressures stable. But watch her closely today. She will need a cardiology consult."
"Mr. F... had a fever and rigors, but better with morphine"
"Mr. C...needed some fluids."
"Oh, and you have three new admissions."
"But nobody coded."
It did go off angrily followed by the overhead PA system announcement the code location. The unit to which I was instructed was located a hike away from where I was standing watch, but it's all hands on deck at nights. By the time I get there, running overpasses across the hospital and climbing stairs avoiding slow elevators, the code team localized to that section of the hospital is firmly in control. Anesthesia team is intubating, intensive care unit crew is assessing and making the transfer arrangements. Seeing the order coming out of chaos, I sign off and head back to my tower. One of the intesivists wishes me a good night, "See you at the next code," he says.
Back to my hematology unit, where I am watching over thirty-four patients trusted to me by the day teams, my spectralink house phone goes off incessantly.
"Ms. B. has a fever of 100.8. She _is_ neutropenic; do you want to culture her and start antibiotics?" "Sure, I'll put the orders."
"Ms. M's platelets are 4."
"Yes, I know. I need to speak with the blood bank since she needs special platelets. Is she bleeding anywhere?"
"Ms. L.'s heart rate is 150, and blood pressure in the low hundreds."
"Please do an ECG, and I will be right there."
"Mr. F. has a temp of 103, his rigoring and breathing at 30. He is going to hospice tomorrow morning. What would you want to do, doctor?"
"I will be right there"
"Ms. C. has soft blood pressures, heart rate in 120, and she has not had made urine since the beginning of the shift"
"Give her a liter of normal saline bolus. I will be right there."
"Hi, is this heme service?"
"Yes."
"You have an admission from the emergency room. He just arrived on the floor."
"Oh. What is he here for?"
"I will be right there..."
I look at my spectralink that says "Bloody Mess" where it should be "Hello, World." The code on my floor is just a matter of time. No time for a restroom break.
Code pager goes off again. _Not_ my floor. Where? East Pavilion. Stairs down, bridges, stairs up. Running through the mental checklist of what to do when I get there. Same intensivist joins me on the run, "Get me there the shortest way." "No problem boss, hang on to your badge."
The day team starts to trickle in. Interns first. Early. Hair is still wet. Time to sign out the service back to day teams.
"OK, so Ms. M. got her matched platelets. She is fine."
"Ms. B. had a small temp, cultures sent, broad-spectrum antibiotics. She is fine."
"Ms. L. was in atrial fibrillation, there were no telemetry beds, so I managed her on the floor. She converted back to sinus. Blood pressures stable. But watch her closely today. She will need a cardiology consult."
"Mr. F... had a fever and rigors, but better with morphine"
"Mr. C...needed some fluids."
"Oh, and you have three new admissions."
"But nobody coded."
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