Morning guys. I'm Siobhan, a second year medical resident. It's a gorgeous, snowy morning and I wish I could spend it outside.
But today I am going into work to do a 24-hour call shift, so here we go!
I've actually given up on the sidewalks, it's so incredibly snowy there.
Okay, just got to the hospital.
Step one is meeting up with team who's here overnight and finding out what issues there were,
hearing about the new patients who were admitted to the team.
Then I'm heading down to the emergency department and I'm responsible for admitting all the patients to the internal medicine team
during the day.
Hey, the team.
Good morning guys, how's it going? It is a lot of scrubs. This tells me there is a lot of people on call.
The whole team. Okay, here we go!
Okay, so why don't we start with some of the night issues, you can tell us what happened with the team.
So you can see some of the signs from last night.
The old pizza boxes, looks like
someone was doing some teaching on the board over there, but overall it looks like it wasn't too busy of a night.
I think that's because there was a big snowstorm last night and patients probably didn't want to come in, unless it was really urgent.
The question is: Does that mean today is gonna be super busy? So
let's see what happens. I don't know,
I'm just gonna check out the board in the emergency room and see how many are probably coming our way for admission.
Oh,
here we go.
Hi, this is Siobhan, the SMR.
Yep.
Yeah, do you mind just getting another repeat ECG and
I'll be in to see them in just a little bit.
Perfect.
Great. Thanks very much. Okay. Okay, bye.
So before going to see a patient, what I typically do as long as they're stable, meaning
their vitals are within normal range and I'm not concerned that things are progressing very quickly in which case I go and see them
right away,
I'll often just take a look at previous notes, get a sense of their past medical history and write it down,
look at their home medications and look at the lab work that's been done by the emergency physicians.
That already
frames in my mind some concerns, so that when I go and see the patient, I can tailor my history and my physical exam
to these issues. And then if something might flag my concerns, I have a better sense of their history
as a context I suppose.
Okay, just saw that patient with the chest pain and
I'm thinking it's probably something called pericarditis. That's the thing I'm most likely concerned about.
That's actually when you get inflammation around the sac of the heart
called the pericardium and it can get irritated, so painful.
It tends to be painful that when people sit forward, it feels better and it's worse when they're lying down and that's pretty classic.
So there are lots of things that can cause it: medications, infections, cancers, autoimmune conditions,
so
I'm gonna send off a whole bunch of blood work and probably most of these won't come back until tomorrow or the next day and
we'll try to figure out what's going on.
All right. Hi, this is Siobhan, the SMR returning a page. Oh hey, I didn't know you were on today.
Yeah, I'm good, I'm good, not too busy.
Sure.
Okay.
Yeah, no problem, no problem. Is the patient stable, their vitals? Perfect! Thanks.
So that was a resident from psychiatry and they've admitted a patient who's now having some electrolyte abnormalities.
So they're hoping we can review the electrolytes. They'll take care of the mental health side,
we'll take care of more the physical medicine and together
hopefully we'll make the patient feel a lot better. And it's so nice, because I actually know this resident from medical school.
It's just... It's nice when you know people around the hospital.
Okay, so just got a third consult and this is the patient who's incredibly dizzy and apparently vomiting a whole lot.
So I finished the first consult.
Second consult I've got the orders in, but I haven't finished a note. And
I should probably go and see this patient first before finishing that note and
then hopefully there'll be a chance to finish up all the typing and documenting.
So I just saw this patient with vertigo,
so the feeling of the whole room spinning and
patient looks so much better than when they first came in. And I'm sort of wondering if they can just go home and don't need
to be admitted to the hospital.
That being said, as a resident I don't have the power to send someone home. I have to run it by my staff,
so I'm gonna give him a call and see if they agree with appropriate follow-up to have this patient go home now.
Just got called by one of the residents. It turns out one of the patients pulled out
their feeding tube and so we're just gonna have to go and put that in now. Otherwise they can't get their medications overnight.
Just got called about a patient who's extremely short of breath. So I'm just heading up to re-assess them right now.
Okay, so I think this patient aspirated, meaning they sort of inhaled
either some food
or maybe it was just saliva and went down the wrong way and
that made it a lot more difficult to breathe and you can see this on the x-ray.
So this patient is gonna be going to a more monitored setting, meaning they can monitor their heart rate, their oxygen levels
and there's just more nursing to patient ratio, because this patient is sicker.
So they're being transferred there now and I'll go in and follow-up and see how they're doing in a couple of hours.
Back to the emergency department now.
Okay, just got two more consults. And now that it's 4:30,
I think I'll just recruit some more help from the other residents that are here today.
They should be done with their patients up on the ward, so I'm gonna page one of them to come down
and see one of the patients?
Hi, can you please page team B medicine?
Yep, three seven zero three seven.
Thanks. Okay, bye.
Okay, so we'll just wait for them to page back.
Hi Siobhan.
Oh hey. Oh my gosh, I can't believe it's 5 pm already.
Me neither.
It's nice to have you back on.
Alright, I have to take the pager. How's the day? Busy?
It's been... It's been not too bad. I feel like it's just been steady, been able to catch up, there's nothing pending.
And the emerge, I don't know.
It's kinda steady, but it's not super busy right now.
Not too busy, okay. Let's not jinx it.
Yeah exactly. I don't wanna say anything. Knock on wood.
Okay perfect, I'll call you.
Sounds good, thanks.
So since a second SMR, senior medical resident, joined me at 5 p.m. there are two of us on and
the emerge actually isn't too too busy. We've decided to divide the night.
So right now I'm actually heading up to my call room at 8 p.m. Wait 9 p.m, totally unheard of!
Ehm... So maybe I'll get a little bit of sleep and then I'll go down around 4 a.m
to take over and do some consults at that point, but of course
he'll call me if things get busy at any point or if they get overloaded and I'll just go down a little bit early,
that's no problem at all. But it's so nice to get some sleep.
It's a good room, but it's freezing! Man, what temperature is it?
Oh no, it's set here,
but it's here. I fear that it actually might be broken.
Oh no. We have to crank it.
Now I'm gonna wake up boiling. So now the priority is food, having some stir-fry and
then take a nap for as long as I can.
All right, it's 4 o'clock.
Apparently, we just got 3 new consults and they look on the sicker side in terms of
breathing and eh.... So I'm just gonna head down to the emerge now and help out doing some of these consults.
Man, it's so cold in here.
Just finished my last note, five minutes to spare. Tim Hortons is now open, so a breakfast sandwiches in my very near future.
It's just about 10 a.m., leaving the hospital now. Wow, so we admitted 20 consults overall overnight.
So, I don't know... Like a busy, steady sort of night. Not really all that unusual.
So we didn't really get slammed after the storm.
So if you want to see more videos about what it's really like to be on call in the hospital as a doctor,
don't forget to subscribe and then like this video. And here are a couple other ones that you can check out that you might enjoy.
Otherwise, I'll be chatting with you guys next week. So bye for now!