醫學生日記2016年4月15日---值夜班

醫學生日記2016年4月15日---值夜班

阿山 （龐靜譯）

普外的手術見習要求我們值三個夜班。對於我們，重點是學習，沒人指望我們是夜班團隊中很能幹的成員。所以，有時侯，上夜班的住院醫對周圍的見習生不太熱心。見習教導主任鼓勵我們要積極爭取這方麵的見習經驗，比如一直跟著值夜班的住院醫，他走到哪裏，你就跟到哪裏，別在值班室睡覺。我的朋友，已經值過夜班了，他說值夜班時通常不能睡覺。如果發生什麽事，我們應該看的，住院醫就得用呼機叫我們。所以多數人在值班室看不到床，而是呼機。

早5:45 - 下午6:00

像通常一樣，我開始了這一天的工作，先加入兒科手術早晨的病房巡查。今天不太忙，整天都是門診。總之，工作天一般都這樣。雖然我們一直在工作，但是並不覺得忙碌或趕著什麽。

下午6:00 - 晚8:00

我結束了一天的兒科手術工作，拿到了夜班呼機。呼機都放在值班室，值班室在醫院地下室的角落，那裏根本沒有聯線電話。唯一可以跟這兒聯係上的就是醫院的呼機。

我換上灰色手術大褂，按規定，我們不能在醫院以外穿這大褂。所以我隻能在醫院食堂吃晚飯。醫院食堂晚飯可選項很少，我吃了炸雞肉，喝了一瓶可樂。今天已經工作了十二個小時，這是我首次往我身體裏添加咖啡因和糖，我為馬上就開始的夜班感到興奮，憋足了勁兒。

我呼叫了值班住院醫，告訴他今晚輪到我值夜班。我等了一個小時，沒反應。這時候，我心裏麵沒譜，是否就該這樣，還是有些事正在進行，我是否應該加入呢？咖啡因和糖開始在我身體內生效，不是警覺和有勁兒，反而是特別著急。我給我的朋友們發短信，他們已經值過夜班了，我問他們怎麽開始的。他們都告訴我安心等待，一定會有人叫我，但是他們都沒法告訴我什麽時候才有人叫我。我坐在住院區的電腦前，旁邊一個同學還在認真地工作。我問他星期五晚上了還在這兒幹嘛，他說一星期六天，從早四點到晚八點就是他的正常工作時間。我心裏有一點絕望。他在結腸科，下一個半星期我就得在那個科了。

大概晚上七點的時候，我的呼機還是沒有任何動靜，我又呼了一次。這回，住院醫給我回話了。他告訴我不用呼他，也不用跟著他。如果他覺得有些事情我應該看的話，他會給我送短信。在電話上，他顯得不耐煩，似乎在告訴我這一夜他最不樂意的事情就是有一個見習生跟屁蟲。所以，我就去了兒科手術工作室，那裏，我的手機有信號，還能接電腦和呼機。

晚8:00 - 淩晨1:30

這段時間我一直坐在電腦前看網上節目。我接到一個急診部門的谘詢呼叫。我直接去那裏取得一個女患者的資料。他們想確定現在她是否需要手術。由於能夠介入的興備，我沒想到應該先仔細看看患者的病曆。我直接去那兒取得患者的病情和她的病史，做了一些檢查。住院醫到的時候，我覺得已經掌握了病人的情況。當我直接檢查病人時，住院醫卻先看了她的病曆。所以住院醫來的時候他根本不需要聽我或病人說什麽。他直接告訴急診醫生病人不需要當夜手術。這時大約夜裏11點，我覺得自己的興奮和努力都白搭了。當我花時間花精力了解病人的情況，力圖解決問題時，人家隻在電腦前花了五分鍾就足夠得到同樣的結論了。

這件事完了，住院醫讓我回去隨便做什麽，他自己也回去做他的事。我溜回我的工作室。這件事令我的精力沉到了穀底，我下樓又去喝可樂吃烤餅。

隨後幾個小時我看了更多的網絡節目，硬撐著睜開眼皮，強迫自己不停地看看呼機，特別擔心什麽事情發生了，我卻錯過了。

最後，大約1:30的時候，我開始覺得特別累，發冷。我朋友告訴我這種反應就是身體體力到達極限的信號。我決定洗把臉，我熬不過這一夜了。我收起我的東西，走去學生休息室。那裏有個沙發，我能躺著睡覺，還不會錯過手機，網絡，或呼機信號。

淩晨1:30 - 早晨5:30

我剛到那裏，我的呼機就開始叫。心肺呼吸科團隊緊急進入手術室。主治醫生和專科醫生都被叫來了。這些人級別高，不用整夜呆在醫院。他們被從家裏叫來監督手術。這已經很不正常了，普外手術也得負責夜裏急診的需要。當時狀況是一個女患者腹腔或食道出血，可能進入了肺部和胸腔。通常這樣的出血隻在腹部，但由於先前的手術，女患者的生理結構已經不一樣了。主要懷疑血流入胸腔，如果壓迫到心髒或氣管就很危險了。所以心肺呼吸科團隊被叫來了。如果血不能馬上止住，患者隨時會死。

我幫忙做了一點手術室的準備工作。我套著無菌大褂，手套和麵罩進入了整個過程。在處理過程中，主治醫生和專科醫生都致力於快點解決患者的問題，要不是為了保住患者的生命，他們誰也不情願半夜來醫院。專科醫生確實也花了點時間教我一點有關這個病情的事情。但是我大部分時間都得撐開切口，讓他們有操作空間。

這個處理過程用了三個小時，我感覺累極了。我必須強迫自己醒著。我的頭不斷有一種被衝了的感覺，就好象身體的血液都流到下麵了，經過肚子，到了腳上。那是一種頭輕了、又重了、伴隨著顫抖想嘔吐的奇怪感覺。我不明白我怎麽可能一直穩穩地站著，手一直穩穩地撐著，可是整個處理過程我都是這麽做的。

切口縫上之後，我為患者清洗，然後清理手術室，幫助把病人送到特護室。走一走，比起站在手術台旁邊，我覺得血液循環好多了。但是，仍然覺得消耗光了。屋裏的人都在打哈欠，你可以很清楚地看到手術醫生們眼睛下麵的黑圈。

早晨5:30 - 6:00

我從特護室一出來，就得到另一個呼叫。急診室有一個B度撞傷。B度指撞傷二級，病人傷得很重，可能傷到了腦袋。A度指問題嚴重到，如果不立即采取措施，將危及病人生命。所以我趕快去了急診室，等待急救車到達。我知道我不會參與治療了，但是我想看看醫療團隊怎麽處理撞傷病人。

病人到了。顯然她吃了很多藥，試圖自殺。她從高速公路下來時把車開到了100 mph, (相當於每小時160公裏），車翻了好幾個滾。急救車到達時，花了半個小時才把她從車裏弄出來。當時，她一直都清醒著，憤怒地尖叫著，一心要死。

她進了急診室，打了麻藥，插了管子。撞傷團隊穩妥有效地對撞傷病人采取急救措施。我以前從來沒見過這麽多人在這個緊急狀況下平靜地合作有序。他們很快地穩定了病人的狀態。我也該下班了。

早晨6:00 以後

我累得暈乎乎的，拖著我自己到了停車場，我站在那裏。太陽從山間升起的景象拘獲了我。一天以前，也是太陽升起來的時候我到了醫院。從那會到現在，我都沒有出來外麵，也沒有再見到太陽。我現在隻想用一分鍾享受陽光。然後我開車回家，洗個澡，直接睡覺。

我睡了大概三個小時，我身體內的生物鍾把我叫醒了。星期六一天我都可以放鬆，做事，按正常時間作息。但是星期天我覺得起不來床了。體力透支終於把我擊垮了，很慘。結果，星期天我連續睡了十六個小時。當我覺得體力基本恢複了的時候，已經星期一了，我又要開始工作了。

Friday April 15, 2016 – Overnight Call

For our general surgery rotation, we are required to take 3 nights of overnight call. It is intended to be predominantly a learning experience for us, there is little expectation for us to be high-functioning members of the overnight team. Hence, sometimes the overnight resident is less than enthused about having a medical student around. The rotation director encouraged us to be very active in our pursuit of this educational experience, such as staying with our overnight resident and following them around the hospital instead of going to the call room to sleep. My friends who had done it previously agreed that generally we should not expect to sleep on these shifts. The residents are instructed to page us when there is something we should see, but that does not always happen. Hence, most people never see the call-room with the bed other than to pick up and drop off the overnight pager.

5:45am – 6:00pm

I started my day as usual, reporting for Pediatric Surgery morning rounds. This day whole day wasn’t too busy, but we had a full day of clinic visits. All in all, this work day was pretty average. We were constantly occupied with tasks, but it never felt hectic or rushed.

6:00pm – 8:00pm

 

I got off my Pediatric Surgery work shift and picked up the overnight pager. The pager is kept in the on-call room, which is located in the corner of the hospital basement. By design, there is almost no internet connection in the room, and absolutely no cell phone connection. The only signal penetrating those walls were that for the hospital pager.

 

I changed into my gray surgical scrubs, which as a rule, we are not allowed to wear outside the hospital. This essentially limited me to having dinner in the cafeteria. The hospital cafeteria is extremely limited in its dinner selection, and I ended up just eating fried chicken tenders and drinking a bottle of coke. After a full 12-hour work day, this was just my first dose of caffeine. Having some junk food, caffeine, and sugar in my system, I felt excited and energetic to get started for my overnight shift.

 

I paged the resident on-call, telling him I was officially on for the night. I wait for an hour and there is no response. At this point, I don’t know if this is typical or if there is even anything going on I’m supposed to be participating in. The caffeine and sugar is backfiring and making me overly anxious instead of alert and energetic. I’m texting my friends who had already gone through this, asking about how they started the night. All of them told me to just calm down and wait, I will eventually be contacted, but none of them were able to pinpoint any time that I should expect. I sat down on the inpatient unit computer next to a classmate, who was still hard at work. I asked him what he was still doing here on Friday night, and he told me his regular hours were from 4am to 8pm, 6 days a week. My insides fluttered a little in despair. He was on the Colorectal Surgery Service, which I will be starting in a week and a half.

 

It’s 7pm and I still haven’t heard anything from my pager, so I send another message. This time, the resident calls me back. He tells me that I don’t need to contact him or follow him around. He’ll just send me a message if he feels there’s something I should see. Over the phone, he sounded disinterested and tired, and sense told me the last thing he would want is a medical student following him around all night. So I moved up to the Pediatric Surgery workroom, where I could still have cell phone signal, computer access, and wait for pages.

 

 

 

8:00pm – 1:30am

 

Most of this time, I was sitting in front of a computer watching Netflix. I was paged for one Emergency Department consult. I was to go down to the ED to get a patient history from a woman. They were deciding if she should go to surgery or not. In my excitement to participate, I didn’t think to look to closely at her medical records. I showed up and took a detailed history about her problem, got information on her background, and did some physical examination. By the time the resident showed up, I felt like I had already gotten a good understanding of the patient’s problem. In the time I was talking to her, the resident had reviewed her medical records instead. So by the time he showed up, he didn’t even need to hear any information from me or the patient. He just placed some orders with the emergency department doctors and said the patient didn’t need emergency surgery overnight. So this is around11pm and I’m feeling like my excitement and effort was pretty useless. I had expended time and energy using my patient interview and problem solving skills when a quick 5 minutes in front of the computer was enough to reach the same conclusion.

 

After this encounter, the resident told me I could go back to whatever I was doing and he was going back to doing things by himself. I slinked back up to my workroom. This experience sent my energy levels crashing, so I went back downstairs to get more Coke and a bagel.

 

I spent the next few hours watching more Netflix, trying to keep my eyelids open, compulsively flickering them over towards my pager, extremely fearful that maybe something was happening and I was missing it.

 

Finally, around 1:30, I was starting to feel extremely tired and cold. My friends all described the feeling of cold as a signal that they were hitting their physical and energy limits. I decided I was throwing in the towel, I wasn’t capable of staying up all night. I grabbed my things and headed towards the student lounge, where there was a couch I could sleep on without missing cell phone, internet, or pager signal.

 

 

 

1:30am – 5:30am

 

Of course as soon as I get to the lounge, my pager starts beeping. The Thoracic CardioVascular (TCV) team is emergently going to the operating room. The attending and fellow had been called in. These were high enough ranked people where they did not stay in the hospital overnight. They were called in from their homes to come oversee this surgery. This was already unusual enough, general surgery is all that is required to handle the overnight emergencies. The fact that TCV was called meant this was an unusual case. The suspicion was that this woman was bleeding from her stomach or esophagus into her lungs and other chest structures. Normally, the bleeding would be into the abdominal space, but this woman had some unusual anatomy due to previous surgeries, so the chief suspicion was that the bleeding was going into her chest, there was significant risk that the blood would compress her heart or airway, hence TCV was called. Also, if the bleeding wasn’t stopped, this patient was going to die pretty quickly.

 

I helped a little to prep the operating room. I scrubbed (full sterile gown, glove, and mask) into the procedure. During this procedure, the attending and fellow were very focused on quickly fixing the patient’s problem, for the sake of saving the patient’s life and the fact that they did not want to be in the hospital in the middle of the night either. The fellow did try to take a little time to teach me a bit about what was going on, but most of the time I was pulling back and holding open the incision site so they could work in the body space.

 

This turned into a three hour procedure, and I could feel my body crashing. I felt like I was constantly fighting to stay awake. I kept getting this rushing feeling that would start in my head, and it felt like all the blood in my body was falling down, through my stomach, to my feet. It was a weird mixture of nausea, light-headedness, being extremely heavy, and feeling shaky. I do not understand how I was able to stay standing and hold my hands steady during the entire procedure, but somehow I did.

 

After the incision was sewn up, I was able to do a lot in terms of cleaning up the patient, cleaning up the operating room, and helping transport the patient up to the ICU. Getting moving and having my blood circulating felt better than just standing next to the operating table, but the exhaustion was still inescapable. Everybody in the room was yawning, and you could see the dark circles under the surgeons’ eyes.

 

 

 

5:30am – 6:00am

 

As soon as I walk out of the ICU, I get another page. We are getting a B-level Trauma in the Emergency department. The B-level means the trauma is second level, where the patient is critically injured and there is suspected head trauma. A-level means there is significant problems to the patient’s vital signs and death could be imminent without significant intervention. So I power walk down to the ED, waiting for the ambulance to arrive. This I know I wouldn’t be participating in, but I would get the chance to see how the medical team cared for trauma patients.

 

The patient arrived. Apparently, she had taken a lot of illegal drugs and was trying to commit suicide. She drove her car at 100 mph (160 kilometers per hour) off the highway, and flipped it several times. Emergency services arrived and needed over half an hour to remove her from the car. During this time, she actually maintained consciousness and was screaming about how angry she was and she just wanted to die.

 

By the time she arrived at the ED, she was intubated and sedated. The trauma team very smoothly and efficiently began the trauma patient care protocol. I have never seen so many people function so calmly as a team in an emergency situation. They were quickly able to stabilize the patient. After they stabilized the patient, it was about time for my shift to end.

 

 

 

After 6:00am

 

I felt dizzyingly tired. I dragged myself into the parking lot, but I had to stop. The view of the sunrise over the mountains captivated me. I had arrived at the hospital before sunrise the day before, and I had not been outside or seen the sun since then. I took a minute just to enjoy the light. And then I drove home, showered, and went straight to sleep.

 

I was able to sleep for about 3 hours, until my internal clock dictated that I should be awake. I was able to relax and function throughout Saturday and went to bed at a normal hour. However, Sunday, I felt like I couldn’t get out of bed. The exhaustion finally hit me, and hit me hard. I ended up sleeping about 16 hours on Sunday. And just as I was feeling more recovered, it was Monday and it was time to go to work again.

 

 

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