Hey guys. I'm Siobhan, a 3rd-year medical resident.
I'm just getting to the hospital, starting a night shift and I'm working on the front lines during the COVID pandemic.
You never know what's going to happen the other day.
All right, so first let's get a pair of fresh scrubs from the hospital scrub machine.
After getting changed the first thing I need to do is get handover from the doctors who have been working during the day.
They give me a list of patients and provide information that's critical to look after these patients overnight.
Good good, great. How are things going?
Alright, so now we're heading down to the critical care unit.
Because I cover those patients overnight, we'll see the staff and hear about the patients.
Excellent, how are things doing? Pretty good today actually. Great! Alright, is that the list? That's the list. Thank you.
And finally, let's head to the emergency department and get the pager for overnight.
Oh hey Matt, how are things going?
Not bad, things are good. Steady as well.
Yeah?
Alright, you want to get rid of that pager?
Thank. God.
Here it is, alrighty. So this is a hot pager, a lot of responsibility when you're carrying it.
So if any patient from the COVID unit, if there any difficulties, the nurses will call this pager.
Of course if the emergency department has any new patients for us to see, consults go to this pager.
If there's a code blue, so a medical emergency, it goes to this pager. So when it goes off,
I'm sort of at attention.
Ok, so right now I'm doing a streak of night,
so I work every other night. And what I like to do when I first come in,
I like to look up the patients that I admitted on my last shift and
see what happened. Because you keep thinking about your patients, you know.
So for instance the ones that I thought were gonna be coronavirus positive, I want to look up now and find out if
they were actually positive. *Pager goes off* Oh no!
Ok. Well, they'll have to wait. We've got our first page here.
Hi, this is Siobhan the SMR returning a page.
Mm-hmm.
Yeah, of course sure. What's the patient's name?
Ok, and what's his blood pressure?
Oh, of course. Yeah, no problem.
He's handing me over to the other emerge doctor. Apparently there are more consults for us. Yeah. Hi. This is Siobhan the SMR.
No problem, that's fine. And do you think that
he has coronavirus risk? Is that something you're worried about? Are those all the consults for now or any others that you know of?
Okay.
Sounds good. I'm sure I'll talk to you later.Okay, bye.
Oh boy! Alright, so we're starting off the night. He got 4 consults right off the bat
and so I'm gonna call some of the junior residents down here to start working.
Alright, this might be busy.
Hi, can you please page team A medicine to this number? Yeah, this extension. Thanks, bye.
Okay, Alex. So I've got a consult for you. You're free, things aren't too busy on the ward.
Alright, so this is a patient who's coming in with shortness of breath. The emergency physicians think it's pretty high risk for coronavirus,
so make sure you're properly protecting yourself.
But I don't want us to just sort of pigeonhole into thinking that it's coronavirus. Keep a broad,
open approach and then we'll review and you can tell me what you think it is. Sounds good.
Oh, I just realize I need to put my mask on, I was drinking some water.
Okay, this is going back on.
Even though I've assigned a 1st-year resident to see the patient, part of my job as a senior resident is to assess all
patients myself and then to use each case as a teaching opportunity.
So in this case, I find a woman sitting upright in bed requiring 3 liters of oxygen.
She tells me that she's been feeling fatigued for about a week and has developed increasing shortness of breath over the past 2 days.
When she started getting some chest pain and then coughing up a few specks of blood, she became nervous and came to the hospital.
She has been physically distancing at home, but her husband works at a nursing home.
So she has possible coronavirus contacts. To complicate things,
she tells me that she's lost 20 pounds in the past 6 months without trying and that
always raises my concern for an underlying illness, like an undiagnosed cancer.
Surprisingly her x-ray looks completely normal. There's no signs of pneumonia or extra fluid on the lungs.
So the question is: What's causing her hypoxia. Why is she requiring oxygen?
Okay, so I saw his 63 year old female coming in from home with 2 days of shortness of breath.
Okay, so I am worried about COVID, but funny her chest x-rays clear. Uh-huh. And she is having chest pain,
so I am wondering about a pulmonary embolism.
Although this still could be coronavirus, I agree with Alex. With a normal chest x-ray,
requirements for oxygen, coughing up blood and a concern for possible cancer, which is a risk for blood clots,
we need to order a CT scan of her chest to rule out a blood clot in her lungs.
Okay, so as an update. Ever since the pandemic, the hospital has been completely reorganized.
We have areas for patients with coronavirus, areas with patients with no coronavirus completely separate so that they don't
contaminate each other. And then we have a special 3rd area in this hospital.
We call it the 'warm unit' and it's basically patients who have symptoms that are so
consistent with coronavirus that even if they swab negative,
we don't trust it and we send them there until we can do extra swabs, extra testing to really decide if they have coronavirus.
Because not every test is foolproof and the swab is neither.
So far we've seen 5 patients and the consults just keep coming.
Yeah.
Okay, sounds good. Yep. We'll come and see him now. Thanks. Bye.
Alright, we'll just see who is free to work...
Mary, are you just finishing up your consult now?
Alright. Do you wanna roll on over here? So okay. We've just got a consult for a 55 year old man
who was coming in with about like 3 days of nausea and his
troponin level is a little bit elevated.
So the emerge is thinking this is probably a cardiac cause, but see him. We will keep sort of a broad differential and let me know
what you think is going on. And if you're worried about him, let me know and I'll come see him with you right away. Sounds good.
Sounds reasonable. Okay, great. Thank you.
Okay, so I just got back from seeing the patient. Mary is gone to see him now and there's nobody else in the consult room,
which is why I've taken my mask off for a little bit.
So I got the story that about 3 days ago he had chest pain, he was sweating,
he was feeling fatigued and then he didn't want to come to the hospital because he was scared of coronavirus.
First of all, he didn't want to bother us and then he didn't think it was gonna be that bad.
So he waited and he's just been nauseous and fatigued for about 3 days now.
Based on his ECG and symptoms
he's describing, I believe that he had a heart attack about 3 days ago and that's causing his ongoing nausea.
So that that just breaks my heart.
I mean... I feel like it's great that people are trying to save resources and help us out by not coming to the hospital if you don't need.
But if you're sick and you need help, this is why we're here.
This is why you've got doctors and nurses working around the clock.
So please come in if you're feeling really unwell because we want to help you, we need to take care of you.
Even if it's not coronavirus.
So we'll have to get an echocardiogram to see what his cardiac function is like now.
So how his heart is actually pumping and how much damage there's gonna be.
So do you guys remember the patient that Alex saw with the shortness of breath earlier?!
So the CT scan is back and it shows there's no pulmonary embolism,
so there's no clot in the lungs. But it does show some ground-glass opacification on both sides of the lungs.
So it's sort of a
non-specific finding.
Generally it can show inflammation in the lungs and
it can be something that we see with
COVID-19, so I'm more and more thinking that she probably has coronavirus.
I'm gonna go check on her again, see how her breathing is doing.
I don't have a lot of other reasons for why she's so short of breath and why she's needing oxygen,
so let's just go see her now.
Oh, gotta get my mask.
Perfect. It's weird, because this sort of echoes what I'm talking in it. So when I'm talking to patients, it feels really weird.
I don't know if you can even hear me through this, haha.
Oh boy... I'm so hungry, I'm so cold. It's that time of the day.
So I'm gonna go heat up some food and grab my sweater and
hopefully perk myself up again.
Yep, okay. So another consult. Oh, I feel badly for Kevin. I know he went to sleep, but I gotta call him.
Hi, can you please page team C medicine? Thank you.
Hey Kevin, it's Siobhan. I'm so sorry to wake you up. I do have another consult for you.
Alright, I'll tell you about it when you get down here.
Thanks, bye.
Hey Kevin, sorry to wake you up. All good.
Alright, I got one for you. Okay. Alright, so we've got a patient who is really delirious.
And we're not quite sure why he's so confused.
So I'll get you to see him and tell me what you think. Alright, it's 5am,
we've had 15 consults now. These guys are working super hard and we're kind of counting down these last couple of hours.
Almost there.
So during the pandemic, I've created this cleaning ritual at the end of every shift to make sure that I don't bring anything contaminated home.
The best part is that I don't have to do laundry.
You just deposit your scrubs back in the machine and the hospital takes care of the rest.
It feels so good to be done. Some fresh air, even though it's raining.
And last night was good,
and I think it was because I had such a great team, such wonderful residents who were like fun to hang out with and plus
clinically they're strong. So it took some of the pressure off of me as a senior resident.
So if you have any questions, if you want to say hi, then let me know in the comments below. And otherwise
I'll be seeing you in the next video. So bye for now. Stay safe!