Sunday, March 6, 2011

House Officer

    It’s been an exhausting week as I’ve tried to go from working nights to working days. I'm glad to be done with nights. I hate trying to sleep when it's sunny out, and going days on end without seeing my husband.
    The rotation is called Night House Officer, or night house, or simply the Ho if we’re feeling scandalous. I think the name goes back to the days when residents really did reside in the hospital, it was their like house. Sometimes when I'm facing another 70 or 80-hour work week, I try to remember that it used to be worse. When my grandfather was an intern, for example, there weren’t any rules about not making residents work more than 80 hours a week. But I guess that’s the subject for another post. 
    Being the Ho is cool actually. Your job for those two weeks is to take care of any and all issues that came up with the patients on the 4th and 5th floors of our hospital between 8pm-8am. Everyone except the OB patients and the ICU/IMCU patients - I think it works out to be 100 people or so. You’d think everyone would just be sleeping, right? Not quite. The nurses call you all night. In a way, it makes you feel important I guess. Some of the calls are easy – someone needs pain medicine, sleeping pills, IV fluids. Some of the calls are more scary – this postoperative patient is bleeding a lot… that one is having chest pain… his fever is up to 104... doctor, the man in bed 26 isn’t breathing well… and you know the lady in 4? her heart rate is 180 now… what should we do? Suddenly all those multiple choice questions on all the tests I took in med school are real people in front of me. I’m proud of myself because as this year has gone by I less often have the urge to say, “What should you do? You should call a real doctor, that’s what!” Usually I know where to start now. I go see the patient, sometimes order an stat ABG, EKG, chest xray, whatever. When I’m unsure of the next step I call my senior resident who is also in the hospital taking care of the ICU patients. On occasion I wake up my attendings, my supervising doctors, who are also on call but at home in their beds.
    One of the calls from a week or so ago was about a 34-year-old who hadn’t been urinating much. It may not seem like a big deal to not pee for a while, but nurses record that stuff and call us for a reason. I knew that this particular patient had liver failure, and that his kidneys were starting to shut down. I went to see him, to push on his belly and make sure his bladder wasn’t distended. He looked even sicker than I thought he would.  His skin was bright yellow from so much bilirubin in his blood. I sat and talked with him for a little while. He told me he was scared that he was getting so sick. He asked me what was going to happen to him. I listened to him for a while, but I didn’t say too much. I knew what was going to happen: he was going to die eventually from this. I had someone else to check on, so I excused myself and left. I almost said something about God, but I chickened out. I remember thinking I'd talk to him another night. I wish I would have offered to pray with him like I did with that other lady that week. I wish I would have told him that Jesus loves him, that God is the one to turn to when you’re scared.
    He went into a coma soon after that, and he died yesterday while I was on call. I pronounced him. I told his family how sorry I was about their loss.
    I missed my chance.

    Most people that I interact with aren’t that near-death. But even with the semi-healthy ones, who knows how much time I really have, how many chances I’m going to get. If you know me, and you think about it sometime, will you pray for me, that I’ll be bold in sharing God’s love? Thanks.