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Friday, April 17, 2009

Nights oooo Nights... (Night 1 of 7)

This is my journey of night shifts. This was supposed to be posted on my first night of 7 cycle, but was too tired to finish writing it on time. Sleep is always my first priority when working, regardless. Next come food & my computer =)

Yes, its my countdown again. 1 out of 7 tonight. =(

My night started with me driving, heavy heartedly, to the hospital. Driving is not that bad at night because not so much traffic. But the only cars on the road can be either ridiculously slow or ridiculously ridiculous. Like always, when I reach this crossroad of Elgar/ Canterbury, I open my eyes real big not to miss it. Dont really want to get fined again for going thru different route, missing every single 1-meter-apart traffic light around BH Centro.

Oh well, if I'm early enuf, I'll go in straight to the parking building without having to get out of my car to swipe open the boom door, which I was early tonight.

1st night of 7, went to grab my pager at the front reception desk. Then off to the resi room.

Like always, there's these familiar faces who're working with me overnight, in their own respective specialties. Some of them are starting their new rotations on Monday, while people like me who're doing their general year, will have to bear another 2 weeks of nights (in which 1 & 1/2 cylcles to go). dduh!!

Some of us would call the evening docs for a handover. Sometimes I do, sometimes I dont, most of the time I would just landpage them. Tonight, no handover by the specialty surg doc & the gen surg doc. Yipppeeee!!!

Approaching 2230hrs, a phone call from ward A asking for fluid order. Done. I like wards that appreciate phone orders.

Then, a phone call from the surg reg X asking me if I was available to help her in theatre for an appendicectomy, which I happily agreed. Then another phone call from another ward, ward B, for a drug chart & pre-op path slip. And another from ward C & D for fluid orders, drug orders, etc. I settled those simple ones before rushing to the theatre.

So went in to theatre on level 2. Darn! Its under construction. Hmmm... which theatre was it. I remember the reg mentioned the number '2'. Maybe its the one on level 4. Okay, went there, got changed, went in to theatre 2. Then she said, she didnt need an extra hand anymore. =( sorta disappointed. I would love to go to theatre at night (which I usually hate doing during the day).

Then, the reg asked me about these 2 patients needing chest X-Rays, if I've looked at them or not. And I was... errr.. which patients? "Didnt the evening intern hand over to you before he left?" I said no. "Naughty boy!!" she said. Oh well. So I got the details of these patients to look at- a pneumothorax post chest tube insertion & a small bowel obstruction post nasogastric tube insertion. Like always, radiology technicians will give you a hard time when you need something done during the night, but after many phone calls to my reg & them back & forth, managed to get those 2 downstairs for the X-rays.

Midnight. Went to see this patient who's initially the nurse sed she's hypotensive, on morphine infusion + PCA. Then all of a sudden it became a case of delirium 2° morphine. Gave 0.5mg IM haloparidol, which is the fair amount to start with for any little old lady. It didnt work. Lucky the surg reg was there & stayed to handle this patient of hers. Me in the meantime, went to attend this lady next door who fell off her bed because of this delirius old lady. It is very difficult to get a proper history from this lady esp. to figure out if whatever symptoms she is having now is related to her fall, apparently she has alwiz been vague. She has a million different medical conditions. Had to order a hip X-ray for her. Had trouble ordering it because of the lazy after hour imaging technician. Lucky the bed manager was there & she sorted it out, after earlier she yelled at one of the security guards who didnt do as she told. (Tsk..tsk..tsk).

Then a few other stuff to handle like IV cannulation, more fluid therapy orders, sleeping pills, anaelgesia, blablabla. I went upstairs to the resi room at around 3+am to get some rest. Somehow I've been tired most of the time even during my just finished 7 off days. Maybe its because of the night shifts, somehow my body is not used to it yet.

While lying down tryng to get some nap, I got a few phone calls for some things like fluids, anaelgesia, blablabla, which somehow I was sooo annoyed because they couldnt be bothered to actually check these things when I went down to the ward & asked them if there was anything else for me to do before I left.

Oh, & somehow when I was there on the bed, I could feel my heart was racing, probably abover 100 bpm already. Dont know why, tried to take a deep breath but it didnt work. I do get palpitations sometimes out of the blue regardless if I'm anxious or not. Half of the time its because of caffeine, which now I'm trying to minimise the intake.

So I woke up to have my sahur & solat. Night shift can be very good for ganti puasa coz u'll be sleeping during the day (of course bangun at times for other solats). Just before I went to solat subuh, I got a fon call regarding a patient who's tachicardic & this is new for her. And another fon call regarding a post-op patient who's in pain after epidural being taken off during midday yesterday. duh!

I didnt go down until I finished my solat. So there I was at 6am, reviewing this tachicardic patient. Apperently she never had any regular GP & in denial that she's old & has multiple medical problems. Now she has newly found atrial fibrillation + a NSTEMI + acute on chronic renal failure + hospital acquired pneumonia + anaemia requiring transfusion. Well, I only got to manage the AF because it was at the end of my shift & the bloods were not back until morning. So dig-loaded the patient & left to review this post-op pain guys in another ward.

It was already 730am when I got to this guy. So I quickly reviewed him, gave some pain killers & talked to the morning surg reg who's supposed to look at this patient but asked me to talk to the other team surg reg who's supposed to come this morning. So there I was, around 830am (supposedly at home already), had to talk to another surg reg who's not at the hospital yet, when he was supposed to. Did some bloods so that they can review them when they're back. Good, no imaging to be done & the surg reg wanted to sort him out when he's in. Thank God he said not to worry much coz he knows the patient.

I went straight to Chadstone shopping mall to buy 'groceries'. But ended up somewher in Myer & got myself a winter scarf. The most comfortable scarf ever. It wasnt that cheap, but it was on offer & I fell in love with it the moment I touched it. =)

Lovely hubby came over to Chadstone & finished the rest of the grocery shopping, while I went home to sleep. (and to start again my night shift routine later)

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