I wasn't prepared for an emergency. I mean, during my entire week of night float, the craziest thing I had to do was disimpact a pregnant lady and ward off the gays who then all claimed that they too had abdominal pain and hadn't pooed in days. (Insert obligatory "full of shit" joke here.)
So on my last night, I was sitting in the resident library, waiting for sign out, and embarrassingly reading about the Kim Kardashian wedding. And then, one of my fellow residents walked in, "Hey, um, do you think you can come help with this patient? There's something wrong."
I jumped up and went with him to the unit, where pandemonium was everywhere. Nurses were furiously clicking on computers, someone was tasked with calling 911 but kept getting the sheriff's office, people who should have been watching their suicidal patients were milling about the nurses' station instead, and no one could tell me where the patient was. After finally getting the proper room number, I walked over, and saw five different doctors and nurses simultaneously assessing the patient all at the same time.
I honestly didn't know what my place was. There was an attending, but she seemed overwhelmed, the charge nurse was trying to put the patient into restraints, and my fellow resident was checking pulses but couldn't find any. And all the time, the patient just laid there, completely unresponsive. I don't know what came over me, but my Northwestern training clicked into place, and I started barking out orders.
Someone call 911 for immediate transfer to a medical center.
Someone tell me his one-liner. What's his name, age, diagnosis?
Take those restraints off.
Did someone do vitals? You, go get me the vitals machine.
Unless you're directly involved with this patient's care, please leave the room and wait outside.
Someone tell me what meds he had today, and if there were any recent changes.
Call phlebotomy; I want a stat blood draw.
Charge nurse, what was he doing prior to this happening?
How long has he been like this?
And all the time, I was going through the head to toe physical exam checklist. Thank you Northwestern for tediously testing our physical exam skills five times a year. I can now do this in my sleep. Sternal rub. Checking for posturing. Checking pupils. Checking his mouth. Checking his pulses. Checking his heart. Checking his lungs. Checking for urinary and bowel incontinence. Checking reflexes. So on and so forth.
I was surprised at how outwardly calm and cool I seemed. Especially since I knew my mind was racing, my heart was pounding, and I was thinking a colorful rainbow of curses, as I tried to figure out how to best take care of this patient with my rather limited County resources.
Before I knew it, the paramedics were there, and as we rolled the patient towards the hospital exit, I told them all that I knew, and my best guess diagnosis (seizure). And halfway towards the ambulance, the patient started coming out of it.
And just as I was finishing the transfer note, my pager went off. Five new admissions would be hitting the floor in about 30 minutes. Fabulous. Just enough time to eat dinner.
