First Night On Call - Oct 2009

I hate mornings.  More specifically, I hate waking.  I am a gifted sleeper, and enjoy my talents with extreme pleasure.  Although, given pristine conditions - circadian arousal, soft sunshine breaking through a window,  waking from a place where I am queen of the world, could arguably be tolerated. Conversely, nothing makes mornings worse than an electronic,  persistent, inhumanely pitched, blare that suddenly and startingly yanks away my contentment.  As a teenager, this was accomplished by my father, sneaking in my room and snatching away the warm blankets that coddled me, exposing my resting soul to the harsh, frigid room air.  I thought several times about turning him into child protective services for these cruel and unusual acts.
 
Beep, beep, beep, beep - damn! shut that thing up.  Haunted by artificial arousal, my pager screamed in my ear at 5 am.
 
This was my first night of call as an anesthesiologist, alone in a quiet hospital.  Beginning the night at 7 pm, I nervously anticipated a page at any moment that would call upon my expertise of airway management in times of emergency.  It was a daunting thought for a newbie.  Yet my lids grew heavy and my pager sat quiet as the hours crawled along.  I drifted off to sleep.  Very uncharacteristically for night call, the entire night I was able to exercise my unique talents.....until that blasted screech jerked me awake.  At which time, I was expected to jump out of bed with "the house is on fire" quickness and respond.  
 
"Could you come quickly, he has pulled out his ET (endotracheal) tube, is paralyzed, sedated, and desaturating." the lively voice on the other end of the phone begged.  I hate mornings.  I move slow, my muscles don't contract properly, my eyes work at 50% efficiency, and my brain is sticky.  But despite the cruel awakening that plagues me incessantly and heightens the aforementioned deficits that persist in the mornings, I ran from the call room (as though there was a fire of course), down the hall, up the stairs, and quickly found the place I was to be.  There were at least ten people in this patients very small room, all standing there with a bit of disbelief, and essentially waiting on me.  I asked them to tell me the story.  His ET tube had been pulled out inadvertently while receiving a routine chest xray that am.  They were quickly losing ground as they were not able to pump oxygen into his failing lungs with just a mask covering his face.  His oxygen saturations were in the low 50's to 40's, which is no where near sustainable for life for any period of time (preferred number is high 90's to 100's) .  He needed the tube put back into his trachea to be able to deliver oxygen directly into his lungs.  Standing at the head of his bed, nervous yet able to control the shakes that accompany the adrenalin pounding through my veins, I breathed deep and delved in.  His sats dropped to the 30's as I looked into the sea of gastric contents that filled his mouth and lungs - no wonder he was having trouble oxygenating.  Suction, tube please, and with ease slid his life line into place.  Color change on the capnogram, bilateral breath sounds, and saturations rising into the 90's, I quietly stepped away to let the rest of the team finish their work.  
 
To let the endorphin surge settle out, I went back to the call room, astonished that I was able to overcome my usual morning inadequcies.  I had not only made it through my first emergency intubation, but successfully navigated it through the morning fog of sudden wake up that often momentarily cripples me.  Ahhhh.  Mornings aren't all that bad. 

Oh, Kristi, this is awesome. I'm so glad you took the time to record this and do it well, and share it. Congrats on a successful morning, oh, and saving that guy's life. You're so cool. 
You Hackworths and your sleep abilities.
Amy

Wow. That was a fun story to read. Way to go on getting the tube in 
efficiently and way to go for choosing the correct field of medicine.

Also, by way of condolensces, I'm sorry you work in a hospital where 
no one in that whole big academic ICU knows how to intubate or 
effectively mask a patient, but alas, such are the woes of many icu's 
I am sure.

Good luck on your next call.

Jeremy

I know- can u believe they weren't doing anything bout sats in the 40s??? I was blown away when I walked in the room and saw that. I mean doing anything short of calling me. 
Sent from my Verizon Wireless BlackBerry
Kristi


Awesome writing and description.  
 I could so picture it all.  You definitely need to keep a blog!
 PS - glad you didn't turn Allen into child protection services.
 Love, Mom