Morning guys. I'm Siobhan, a second-year medical resident.
I just got to the hospital and I'm starting at 26 hour call shift for nephrology.
It's the weekend and at a time like this, you have no idea what the day is gonna bring. Is it gonna be filled with pages?
Emergencies? Will I get some sleep? It's kind of weird coming to work and not knowing what to expect.
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Okay, so we're here. We're in the doctor's room.
There's a bunch of computers and it's a place where we can do work and be found easily.
So I start out the day, every day by looking at my patients' blood work.
Just to make sure there's nothing abnormal that I need to fix right away.
Most of the patients that I'm seeing are on
hemodialysis. Meaning their kidneys are not working properly,
so they actually need a machine to help clean the blood and do the job of a kidney.
So if you want to learn more about that,
I actually did a video about this and I'll link it above so you can take a look.
Anyway, let's get down to the blood work first and we can chat more later.
Oh page.
Hi, this is Siobhan from nephrology returning the page.
Sorry, what's the name?
Thanks for letting me know. Yep. Okay thanks. Okay, bye.
Okay, so the nurse just called me telling me that one of the patients has a very high potassium and that's called hyperkalemia.
And that can be really dangerous, because it can cause some fatal heart rhythms.
So party number 1 is to stabilize that heart, so that it's safe. So I'm just going on the computer right now and
I'm putting in
calcium, IV calcium.
We'll do it once
through the IV and do that once now. I'm just signing it. Okay.
So this will stabilize the patient's heart. Next we need to actually
shift the potassium from in the blood into the cells.
And we do that by giving some glucose and giving some insulin and the insulin is gonna shift that into the cells.
But that only is gonna last for a little while, the key is we have to get it out of the body.
So then we need to give something called kayexalate, which is a medication that binds
potassium and then puts it into the patient's poop so they can poop out that extra potassium.
So we'll put those orders in now for the glucose, the insulin and the kayexalate.
Then we'll just go over and
chat with the nurse to let her know that we put these orders in and
go and see the patient.
So the patient is now aware of what's going on, the nurse is grabbing the medications as we speak.
So now on to the next patient, the next bloodwork, see what else is going on.
So now that we've seen the sicker, more acute patients on the nephrology floor, let's head over to the orthopedic surgery floor.
Because we've got some patients there that have some broken bones. They've been admitted under surgery, but they're still requiring
dialysis, which is where we come in. So just going over there to look at the blood work and get their dialysis orders sorted.
Hi, this is Siobhan from nephrology returning the page.
Sure.
The nurse is getting the emergency physician.
Oh, two
pages at once. We'll get that one after. Yes. Hi, this is Siobhan from nephrology returning a page.
Sure and how much oxygen are they on right now? Okay, sounds good. I'll be down soon.
So the emergency doctor has asked me to see a patient who has pneumonia.
Came in with a cough, you can see it on the x-ray and then
they're requiring a bunch of oxygen, so they've got to stay in the hospital. But you might be thinking: Why is
nephrology, the kidney doctors, why are they admitting a patient who has pneumonia?
Good question. That's because this patient had a
transplant, a kidney transplant a couple of years ago. And any transplant patients will automatically get
admitted under us, under nephrology.
So this has been by far the coolest part of this rotation and that's being on the transplant team.
Having a new organ placed into somebody else as a
life-saving measure, getting people off of dialysis, like it is so cool this is possible.
I'm totally like nerding out, geeking out.
Actually, let me tell you a couple of cool facts about kidney transplant.
Okay, first cool fact is that surgeons, the urologist, don't remove the old kidneys. So they just put in a new kidney
in a slightly different place, so people end up with three kidneys inside of them. And the rumors are true:
You really only need one kidney to live and 1 in 3000 babies are only born with one kidney.
Kidneys can be donated from someone who's alive,
like a live donor or when someone's passed away,
so that's when someone is called a deceased donor. And these new kidney transplants can last
10 to 20 years.
Especially if someone is taking their
immunosuppressive medications regularly. And the surgery only takes 3 hours, which to me is actually pretty incredible.
And now if you're adventurous or you're interested in surgery or think it's really cool.
There was actually a livestream of a living donor transplant that was done a couple of years ago here in Canada.
And I'll actually, I'll link the video above because it's really neat and should be seen and on that note...
I've got a page. So let's see what that is.
Hiy this is Siobhan from nephrology returning a page. Yeah, I'll put that in the computer. Thanks. Okay, bye.
A patient has been... Their sugars have been running high.
It got changed around after surgery and we're just finding the right balance again. So just...
It's an easy fix.
Alright, let's actually go and see this patient now, a transplant patient with a pneumonia.
As I walk into the room, the patient is coughing and requiring oxygen to breathe normally.
It's a pretty classic story. Her partner has been sick recently and she hasn't been feeling well for the past 3 days.
Her white blood cell counts are up and her chest x-ray shows a consolidation.
All these things are pointing towards pneumonia.
Just back from dinner.
So now I'm gonna be heading upstairs to see some patients and follow up on the pages that I got over dinner.
So exciting news: My staff nephrologist just texted me and said that we may be getting a transplant tonight.
So right now he's finding out about the health of the donor, health of the kidney, if it's a good match for
somebody on the transplant list. If someone matches up, it's a good match,
then that person is gonna come into the hospital tonight and we'll get them prepped for surgery,
probably in the morning. So it's incredibly exciting for someone who's been on the transplant list for years,
but it's also a little bit bittersweet.
Because it means that someone just passed away and that's where that kidney is being donated from.
So we will wait and see.
I fear if a
transplant is coming I might as well just stay in the hospital and go and get a call room, because it's probably gonna get busy tonight.
Hi, this is Siobhan from nephrology returning a page.
So it's 7:30 now, I have just woken up. It's time to go up for handover in the morning.
But I decided to check how many pages that I got and I ended up getting
38 pages from 5:00 p.m. until 7 a.m. So really high number of pages.
I think the luck of the draw on a given night, but I couldn't show them all to you guys, of course.
Too bad though, never got a page saying that the transplant came in. So something must have happened.
This happens all the time, you need to have a good match.
Maybe next time.
Finally done, heading home.
If you enjoy seeing call shifts like this or wanna see interesting cases in medicine:
Don't forget to subscribe, because there are lots of more videos like this. Otherwise I'll be chatting you guys next week, so bye for now.