Since childhood, I've always been a planner
Organizing my days to be efficient and practical
But as a doctor, your time isn't your own and it can feel like you're being pulled in a million directions
phone calls, notes, medical emergencies, anaphylaxis, a code blue.
Walking into the hospital in the morning, you have no idea what's coming.
Morning guys, I'm Siobhan, a second-year medical resident. I just got to the hospital.
It's actually a couple minutes after 7:00
so I'm kind of running a little late gotta hurry and
um, I'm just meeting up with my staff physician and we're going to be seeing the new patients that came into
the emergency department overnight and get to know them.
[violin music]
In the morning,
the resident or medical student who was on call last night tells the attending physician all about the patient
they admitted, including their diagnosis and then their plan.
This is the moment that a lot of us get feedback and teaching and as a medical student I actually found it
nerve-wracking, but now this is an opportunity that I really value
Ok, so it's just about 8:00. Why don't we just go and grab some coffee before we go to teaching?
[Grace] That sounds great
Ok, it's my treat because you've done such an amazing job. Grace actually came in early to do a consult
She's an elective student. She's - yeah. She's doing an awesome job. It's great to have her here
[Grace] Thank you.
Ok need sustenance
Alright got a coffee or tea
You got your coffee
[Grace] Coffee!
Perfect. Teaching time.
This morning we did simulated scenarios focused on how to manage common emergencies we see in the hospital
So now, it's time to meet up with the poor
exhausted resident who was on call overnight and hear about any issues that came up with their
patients so that we can follow up with them during the day.
Oh hey guys are you guys printing the lists?
Yeah.
Awesome. Ok, perfect.
Hey um, how is the night?
Oh, it's pretty busy.
Yeah, how many consults?
Five.
5 consults seriously. Oh my gosh. How many do - you had to do 5 yourself?
Yeah
Shoot
Ok, the team had like 20
Oh my gosh
Something like that, yeah.
You guys had a busy night.
Yep
Ok we'll get a handover from you soon. so that you can head on home and get some rest.
Yeah, I would appreciate that very much.
[laughter]
Next I assigned each medical student and resident
specific patients to see and I always like to emphasize which patients actually need to be seen first
So whether they're the sickest or they're actually doing well and they're getting ready for discharge.
So we've got two patients downstairs who are ready to go home
One of them had a heart attack had a stent placed to open up their blood vessel
And now was doing really well, ready to go home
The other one came in confused and we've sort of fixed the underlying cause which were some
electrolyte abnormalities because of a medication
So I'm going to go downstairs to meet Jennifer, one of our excellent medical students, and she's getting things set up
So I'll help go through it with her and sign off on the paperwork that she's done
[pager beeping]
I got paged about a patient with a new rash.
When I arrived to see her, she told me that her chest was feeling a bit tight
and then talking to her nurse, I found out she was just receiving her first dose of an IV antibiotic.
So we checked her vitals and luckily they were all normal but on physical exam
I found her lungs were wheezy, and she had no history of asthma or lung disease, so it shouldn't sound like that.
I'm really concerned she's having an allergic reaction to the medication.
So immediately we stopped the antibiotic and we even took out the IV that it was running into
Then we gave her some epinephrine (just like an EpiPen) and we gave her some benadryl and Bernadine
and a steroid called solu-medrol.
Then I ordered some bloodwork to rule out anything else that could be causing this.
I was so relieved when her symptoms started to quickly resolve and her lungs no longer sounded wheezy.
Okay, so the situation is resolved
But I do want to call family and just update them and let them know what happened and that, um
You know the patient is safe and okay, but I'm sure they'd like to see the family
Okay, great. Okay. We'll see you soon
Okay, so um really lovely family so they've been updated
Um, I've also got a text my um, my staff physician so that they're way aware of what happened
Um, I make sure that the chart- they know this is an allergy or what were thinking is an allergy and
Um, I'm actually gonna move this patients to an obs bed, meaning an observation bed
So they're on closer surveillance and just make sure, um, that their breathing is okay moving forward
and we can have attention very quickly if anything happens.
So guys
I really really want to stress how incredibly important it is to take allergies seriously
So I actually grew up with a deathly allergy to milk products and I was fortunate enough that I grew out of it
Um, but I used to carry around Epi-pens, but I never wanted to and I parents had to get on me
so I just want to say if you have an allergy it is so important to carry it and
If you need to use it you use it and you don't carry around ones that are expired. All of this is critical so
Um, yeah, I- I really can't stress it enough
especially when you see someone as sick as this patient was
So I just finished up lunch and noon-hour teaching and now I'm heading down to the
I guess health and wellness center here and the reason is because I need to get a TB screening test done
Um, basically, I
have to go on away electives, meaning I go to a different
university, a different hospital and I do an elective in an area that I think I may want to pursue
a subspecialty in and so I'm gonna be doing
rheumatology at a different hospital and they require the TB screen testing
So maybe I can show you guys what that's like. I dunno, have any of you guys had one of those done before?
The TB skin test is an intradermal injection
So fluid with some purified protein from the bacteria is injected under the skin and it actually raises up like a wheel
Then you come back in two to three days to have it read as positive or negative
But the good news is that TB is actually curable
So the important thing is just finding it if you're positive so that you can get treatment.
[pager beeping]
[footsteps]
Okay, so just finished up with that code blue
Um, turned out it was a patient who was having a seizure
So we gave, um, a fair a bit of Ativan
stopped the seizure and then sent off a bunch of blood work just to make sure we know the cause.
I think in the end this actually, um, was probably due to alcohol withdrawal
Um, but we're gonna just do a full workup or actually the- the team looking after this patient is gonna
do a full workup because
I was just there, um
as sort of the- the code blue, uh, captain, uh, today
Um, yeah. So anyway, I guess I get to just go on with my day seeing our patients at this point.
Heading to meet the team now to review all the patients that everyone saw during the day
I've seen most of them so I'll have my opinion we can see if there are teaching points or, um
If we all have the same opinion, I don't know, that usually doesn't happen
[laughter]
It's almost 6 p.m. I'm having a little bit of a snack
I'm on bridge so that I'm bridging the day and the night
which means I now have to go down to the emergency department into a
consult before I can go home so off I go
Just finished the day ended up being actually a pretty simple consult
patient came in with a really really high blood pressure and high sugars because
Um, the patient had stopped taking their medication for the past year. And so, um we just need to get started back on them
so
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Check out these videos if you want to see more in the hospital on call
Um, and otherwise, I'll be chatting with you guys next week. So bye for now