Morning guys. I'm Siobhan, a 3rd year medical resident.
I'm just getting to the hospital and starting a 26-hour call shift in internal medicine during the COVID pandemic.
Alright, so today I'm the senior medical resident for the internal medicine service and we're actually going to be on the COVID positive floor.
So it's the floor where patients who have Coronavirus or have suspected Coronavirus are located.
I'll be supervising the junior residents as well. So there are 3 junior residents on the team.
So it should be a pretty jam-packed day and then we're on call tonight. So the fun will keep going.
Alright, let's go and see the team and
start seeing patients.
Here's the team of 1st-year residents: Jaymee,
JB,
surprisingly similar names, and Tian.
We divide up the patient list and assign about 6 to 8 patients per person and then we get down to work.
Multidisciplinary rounds is an important time when the medical team meets with nursing, pharmacy,
occupational health, physical therapy, social work, dietitians, speech and language pathology and spiritual care.
This type of collaboration allows us to take a much more holistic approach to patient care and
ensures that health care providers are all on the same page.
Okay, so we're done with rounds now.
I just wanted to check in and see what we've done to this point, because we've got 2 new patients that are coming in from the
emergency department. Jaymee, where you at now?
I'm going to see the 1st new one and then follow up on some tests that are outstanding for patients today. Okay, fantastic.
So 1 done and anyone else free right now to do a 2nd consult?
You want it? Okay, that is fantastic! And then 3rd one is coming your way. That's... Okay,
so we don't know when that one's coming yet, but I'm sure it will come later this afternoon. Okay, sounds good.
Let me know if you're concerned about anyone and we'll go from there. Okay, great. Thanks.
So this new patient is coming in with a pretty big pneumonia.
And on the chest x-ray it also looks like there's a pleural effusion.
So I'd like to go and grab the ultrasound and look at his chest myself.
And if it looks like there's a large pocket of fluid, we may actually drain that out.
So let's go take a look and see how much fluid is there.
When a pleural effusion is caused by a pneumonia it's called a parapneumonic effusion.
This happens about 20 to 50 percent of pneumonias.
Getting a sample of the fluid can help us know exactly what bacteria is growing,
which helps us target our therapy with specific antibiotics.
If the fluid coming out is filled with pus,
then we know it's important to place a drain into the chest, because antibiotics alone will rarely be able to clear the infection.
There's actually quite a lot of fluid, so we'll get the supplies and do a thoracentesis at the bedside.
Okay, so we're done seeing all of our patients, we have 24 patients that we've seen and now I'm just
heading upstairs to meet the other residents for a teaching session. It's all on Zoom, because it's virtual because of the coronavirus.
So I'll just go there now.
Alright, so now that we're done with teaching, this would be the end of the day, but we're lucky enough to be on call.
So the day and the night continues. Ehm, I think... Let's go and grab a call room.
Now this is a totally new hospital for me,
so I don't even know where the call rooms are or what they're gonna look like, so we'll go and find them now.
Oh wow, this is so nice. Oh my gosh, this is fantastic.
Bed, computer, TV.
What more could a resident ask for? And a window! You never get a window... That's so nice!
Wow, it really is the little things that matter. [Laughter]
Hopefully I get to spend some time in here today. [Pager beeping] Oh man!
Okay, paged already. I think I jinxed myself. Alright, let's see what this is!
Hi, this is Siobhan from internal medicine.
How high was the creatinine? And you said you had a 2nd patient as well?
Sounds good. Yeah, we're happy to see them. No problem. Thank you very much, bye.
Okay, so that was the emergency department.
The physician there has 2 patients for us to see: one is a patient who's had
profuse diarrhea for about 2 weeks and comes in extremely dehydrated. So we have to figure out what's causing the diarrhea.
And the 2nd patient comes in very short of breath and apparently they've been in contact
with someone who was in contact with someone who was positive for Coronavirus.
So possibly it could be COVID,
although there is so many things that cause shortness of breath. So we'll see.
One of the kind of cool things of this hospital is that because we have beds upstairs,
they are just gonna transfer the patient upstairs and we'll see them on the floor.
So we don't even have to go down to the emergency department, so that's really different than the other hospitals I've worked at before.
So anyway, I'm gonna tell Jaymee and Tian that there's some
consults to see and in the meantime, I'm gonna look them up on the computer and find out a bit more about them.
Okay, so now that I have read about the patient and their past history and all the imaging that's been done here,
I am gonna go downstairs see the patient and then be able to review with Jaymee.
Hey, Jaymee.
Ready to review? [Jaymee:] Yes. [Siobhan:] Excellent, okay.
[Siobhan:] Alright, so tell me about this guy.
[Jaymee:] Okay. So this is a 57 year old gentleman who comes in from the community.
He's a pretty healthy guy other than being a smoker. So he smokes about a pack a day,
he has for the last 35 years. [Siobhan:] Okay [Jaymee:] But otherwise he's not on any medications,
he's never had any surgeries and he comes in because he was feeling short of breath. His concern
is that somebody at work tested positive for Coronavirus. [Siobhan:] I see, okay. [Jaymee:] So there could be some other things going on.
We know he's been smoking for quite some time.
But reasonably he's concerned about that,
and so we've done the swab for COVID as well as a chest x-ray and some other investigations.
Just to get down to the bottom of this.
[Siobhan:] Absolutely, Okay.
Alright, so there's no obvious pneumonia on this chest x-ray, although that can be the case early on in COVID-19.
We do see that his diaphragms are very flat,
which tells us he's trapping air in his lungs and he's not able to blow that air out on expiration.
This is frequently seen in a condition called Emphysema, which is commonly caused by smoking.
So he probably has undiagnosed lung disease.
His blood work shows a few abnormalities:
His white blood cell count is elevated, which goes in favor of an infection.
His kidney function is abnormal and there's a small increase in his liver enzymes.
We still don't have a firm diagnosis, but for now, we'll start by giving him some IV fluids for dehydration,
antibiotics for possible infection and to look into his liver abnormalities, we'll get some more blood work and an ultrasound.
At this point it could still be COVID, but the results of the swab won't come back for at least 24 hours.
Alright, so we've seen 11 consults now.
We're totally caught up for the night, which is good.
But I realized that I didn't actually bring any food and that Tim Horton's in this hospital closed already.
So I'm like stranded. I should know better,
I've done these call shifts for 3 years. I don't know how I forgot about food, so that sucks.
I'm hungry!
So, I was just texting Jaymee and complaining that I'm gonna be cranky
and that I'm hungry and that I won't be as fun of a senior and she texted back telling me that
the Wellness Center actually stocked one of the lockers here
with lots of food and snack during the pandemic to raise people's spirits. So now I've got the code.
Let's go check it out and see what's in there. Hopefully people haven't raided it already.
Wow, oh my gosh. It's an actual feast!
Perfect.
Okay, so food in the belly. Talked to the junior residents, things are okay on the ward.
Dare I say it?! I think this is the moment to get a little bit of sleep. So let's take advantage of that right now.
[Pager beeping]
Ah man, you've got to be kidding me!
Hi, this is Siobhan from internal medicine returning a page.
Sure, no problem.
They're just gonna go get the emergency physicians. Apparently 2 of them want to talk to me, it's never a good sign.
Well, okay... So much for getting some sleep.
We've got 2 patients to see down at the Emergency Department.
Both of them actually have metastatic cancer, so very advanced cancer.
One is breast cancer, one is pancreatic cancer and they're both coming in with a fever.
And normally these patients would be admitted under the oncology service and managed by the cancer doctors.
But during the coronavirus pandemic, because we really want to protect these immune compromised patients,
internal medicine are seeing all
these patients, making sure they're cleared from a Coronavirus standpoint and then they get transferred over to the oncologists.
So it means that we're seeing a lot more cancer patients these days who are on chemotherapy and on very advanced therapies.
So it's interesting,
it's sad, it's different.
I don't know. It's... Actually it weighs on my heart at times heavily.
I would find it difficult to work in that field all the time, because
you hear stories and they just keep going around in my mind and I just can't really stop thinking about some of these patients.
Especially those who get cancer at a really young age. It just seems so unfair.
Anyway, let's go and see what... Let's go meet these patients.
Okay, so Jaymee saw 1 patient,
Tian saw the other, and of course I've reviewed the patients of both of them. We had a plan.
I think we are caught up. I feel like I'm having a moment of deja-vu, but I think we're caught up now.
Okay, let's try this whole sleep thing one more time, shall we? Alright, goodnight.
What time is it? I'm worried I've missed a page. No, I guess not.
Oh man, I keep waking up. I think my body is expecting to get a page.
[Alarm clock ringing]
Alright...
Well, we got some sleep and
now it's time to get up, look at some of the morning blood work from the patients and then we'll head downstairs and
meet up with the team.
Yeah, tell them about the night. Handover and then we can get out of here.
Alright, and that's it. Done with another successful call shift and I
really really want to thank the whole medical team, the nursing team, the allied health professionals for joining in on this video.
It means a lot to be able to really show what
everyone is doing, because it's never just 1 person acting alone.
Anyway, if you want to see more videos like this, be sure to subscribe. And otherwise, I'll be seeing you in the next video.
So bye for now!