#18 / #19 / #20: The Program Director's service is kicking my butt

Well, it was nice to hear from several of my friends and family that they missed my blog this past week. I was absent from the "blogosphere" because, contrary to my previous post, the Program Director's service is NOT easy. In fact the service is the hardest one I've done so far. We have two operative days per week in which we run two operating rooms each day. Most of the patients are ones who had several failed operations by other surgeons and my attending fixes up everything and connects it so their gastrointestinal tract finally works. These patients had lived with a lot of pain prior to their operations and they are often on chronic pain medicine. What this translates into is a bunch of patients to take care of after surgery and their post-operative course is difficult and protracted. Or stated another way, there is a lot of shit to deal with (both literally and figuratively.)

The last three call nights have been very busy. Thursday night I was in the operating room for the first part of the call, so I was very behind and all the other interns signed out a bunch of post-operative patient checks for me to do. Then there were two patient admissions at 3 AM and 5 AM and therefore I didn't get any sleep at all! I don't even remember what Monday night's call was like. On Friday night, there was some really poor nursing, and I got a bunch of pages from those nurses. Each of the pages could have been translated into: "Please do my job for me." There was the time that I had to go into the room of a patient with a nurse and had to talk to the patient in order to convince them to take their medicine (her nurse should have been able to do this.)

Then there was the time that the patient had a fever of 102 degrees on the night just after they had surgery. The #1, #2, and #3 cause of post-op fever is when patients don't breathe correctly. I asked the nurse whether the patient was using their incentive spirometer (a breathing machine) and she said, "What is an incentive spirometer?" Then she called me back two hours later (at 5 AM) and said that the patient WAS using the incentive spirometer but he still had a fever. I went to the patient's room and she had taught the patient to use the breathing machine UPSIDE DOWN and EXHALING instead of INHALING. I sat in the patient's room and taught him how to use the machine and in 2 minutes he no longer had a fever.

I'm going to start calling up my attendings every day every time I get paged and say "Please do my job for me."

Last call nights Thursday, September 8th / Monday, September 11th / Friday, September 15th
Amount of sleep last call nights: 1 hour / 1 hour / 2 hours.
Currently reading: The News and Observer Weekend Paper!
Currently watching: Miami Football (Hurricanes and Dolphins) - neither team is doing so well these days.
Next call night: Tuesday, September 19th