A silly little blog for me to drop the excrement of my mind.
Published on January 22, 2007 By BlueDev In Life Journals
Some days the you control the chaos.  Others, the chaos controls you.  You just sort of ride the waves, hoping to keep your head above the surface.  Around the Jones home, we are still sort of reeling from the chaos of last week.  Alive and well, but our heads are spinning just a bit.

I am currently on my second tour of the Trauma service here at the hospital.  It is a crazy service in that we get all the traumas that come in, as well as any general surgical consults that require operative intervention.  As far as the general surgical services go, it is easily the busiest.  Last week we hit our peak at about 10 patients in the ICU, 25 on the floor, and another 7-8 on the consult list. 

But not only were we very busy, we were also understaffed.  The second year resident was on his week of vacation, one of the other interns was off interviewing for another position, and our nurse practitioner was no where to be seen (not that she ever is though, so no change there).  The service usually runs as follows: The chief resident runs the show, goes to the OR, has clinic one day a week and helps out with the traumas.  The third and second year residents alternate, with one being in charge of the ICU and the other seeing the numerous consults that get called in and taking care of the new traumas coming in.  That and going to the OR as well.

That leaves us interns to take care of the patients on the floor.

So last Sunday our third year resident sends out an email asking for some help on Monday in the ICU.  Trying to be a team player, I offer up my services.  So, I write the ICU notes, round on those patients, and try to make sure they are taken care of.  I am feeling a bit overwhelmed, trying to quickly assimilate the information of their hospital stays and very complicated courses.  But I made it through.  I was on call that night, so I was going to be staying in house anyway, in no hurry to go home.  Things were mostly controlled.

Tuesday was beautiful as I had to leave by noon (work hour restrictions: we aren't allowed to do more than 30 hour shifts).  Went home, tried to help a bit around the house and had a generally nice afternoon.  Still doing okay, though I was still in the unit, even though the initial plea was to help on Monday.

Wednesday finds me still in the unit.  No big deal.  I can handle that.  Our third year resident was on call the previous night, so he was getting ready to leave.  I ran the unit list with him and as he was heading out the door he hands me the 3009 pager.  I quickly say "No", and inform him in no uncertain terms that the intern should not be the one carrying the 3009 pager.  See, this is the surgery consult pager, as well as the trauma pager.  But he informs me that the chief told him to give it to me. 

Well, the unit notes were done, so I head to the floor to help my fellow intern who is buried under an avalanche of floor patients.  I write a note or two for him when it happens: the pager goes off.  I pull it out of the clip and look at the dreaded text message: Adult trauma: ETA 5 minutes. BAM , just like that my heart rate goes up.  I start to feel a little flushed and bid my fellow intern farewell.  I run down to the trauma bay and immediately page the chief.  He is just getting out of the OR.  He'll be there are soon as he can.  He tells me to just let the attending know I haven't hadATLS (Adult Trauma Life Support) or actually run a trauma before.  I am told he will walk me through it. 

One problem.  The attending isn't there.

A nurse asks if I am going to be running the trauma, to which I can only smile sheepishly and nod.  I tell them I haven't done this before and they just inform me to do theABCs and then a head to toe, informing them of any findings.  Great.  I can do this.  And no sooner do they finish saying this when the patient comes through the door.

5 hours and three traumas later I nearly dragged myself home.  Exhausted, a bit exhilarated, but definitely ready to not do that again for a while.  Of course, as per the cliche, I arrived home late, my wife had to miss her choir rehearsal, but we were okay.

Thursday morning was the dawning of another call day.  Into the hospital around 5:45 and we start rounding.  Today I was told I wouldn't be in the unit.  I would be helping on the floor.  Cool.  At 6:45 I get a page.  From home.  Using our code that means "call immediately".  These pages always get my heart racing as well.  I call home to hear my sweet wife's anxious voice say "I just woke up and the house is full of smoke."

I'm stunned, even if for just a second.  I think I just dropped a load in my pants.  "Can you tell where it is coming from?  Can you get out?  Okay, get the kids, get outside and I will be right there!"  I run to the unit, find the team and tell them "My wife just called, our house is full of smoke, see ya."  And I'm off.  Running through the halls, through the parking lot, driving at an unsafe speed all while trying to dial my wife's cell.  No answer.  Heart racing.  Every spare second, scanning the sky to see if our new house is going up in flames. 

Much slower than I might have wanted, I finally pull down the street, expecting to see a fire truck hosing down our abode.  But, to my relief and/or dismay, there is none.  I pull into the driveway, my wife is standing outside with a fire extinguisher.  I grab it out of her hand and burst through the basement door.  I can't see a thing, thick smoke choking my vision.  But there is no heat.  No crackle of flame.  I rush to and open a window, scan the basement, not seeing any obvious flames, then run upstairs, again opening doors and windows in an effort to get the smoke out. 

And out it rushes.  The house clears and we find the culprit.  Something in the furnace caught on fire.  Black soot and ash cover the ground below it.  A quick call to the oil company and they are set to come and inspect it.  To our immense relief and gratitude, there is no other damage.  Everyone is safe and the house is fine.  The kids are safe at the neighbors, the smoke has cleared, help is on the way, and so duty called.  60 minutes after the initial page, I'm headed back, back to work.  Since I am on call, and our service is just so hammered, I can't take the day off.  I can't stay home and help my family.  Times like that I wonder at my choice of careers.

It turns out that, contrary to what we had been led to believe, the furnace had not been cleaned out in some time.  Something got caught in the filter and caught on fire.  But the furnace is fine.  It is cleaned out now, and the house has been cleaned and aired out.  Minor extra drama, my wife calls that night saying that the CO (carbon monoxide) monitor is alarming (she replaced the batteries) and wondered what to do.  My gut tells me it is defective, but I don't know that I want to risk my family on that.  She calls the oil company, and goes to spend the night at some friends.  All is well, no CO, just a bad monitor. 

But better safe than sorry.

Friday, I'm out again my noon.  Home to help with damage control.  I put up new smoke alarms, as the others obviously didn't work.  Install the new CO monitor as well.  Everything is back to normal, and we can finally take a collective sigh of relief.  What a crazy week it was.  Now I'm just glad it is over.
on Jan 22, 2007

You didn't tell me about any of that stuff the other day.

Crazy, crazy stuff. Glad to hear things turned out okay, and that it was just something in the furnace.

Hope all continues well.
on Jan 22, 2007
Chaos is actually a principle of chemistry in the form of entropy....fun fact.

Now that was one hell of an experience...whew.

on Jan 22, 2007
Boy, thank God for those nurses and for your perseverance. Sounds like things haven't changed much over the last 25 years and they're also not much different between Canada and the US. Lately, though, I've noticed the Ontario Medical Association making physician health more of a priority in their negotiations with the government. Seems like you have a big load and a big set of shoulders to carry it. Good luck with what lies ahead.
on Jan 22, 2007
Co detectors have a fairly limited life span. The actual detectors become less sensitive over time, a few years I believe, so good you got new ones. Glad your family is ok.
on Jan 22, 2007
good to hear that you are keeping up and that everyone is safe and sound.
on Jan 22, 2007
Heya mate,

Wow, how chaotic indeed. I'm real pleased to hear everything on the home front was fine too. Hope you get to have some well deserved downtime soon, mate.
on Jan 22, 2007

You didn't tell me about any of that stuff the other day.

Yeah, it was late, and it just wasn't a story that would tell well over IM.  Sorry about that.

Now that was one hell of an experience...whew.

Heh, yeah, that is one way to put it!

Boy, thank God for those nurses and for your perseverance

Wow, ain't that the truth.  One thing I have learned, already this early in my career is this: Nurses can save your life, or make it hell. 


on Jan 22, 2007


The actual detectors become less sensitive over time, a few years I believe

Ah, good to know.  Thanks for that info!

good to hear that you are keeping up and that everyone is safe and sound.

Thanks Nic!  We are hanging in there.

Hope you get to have some well deserved downtime soon, mate.

Well, actually I am heading into a stretch of a couple of weeks with no days off.  Oh well, such is medicine.  Thanks for the support mate.

on Jan 22, 2007
Gosh, I'm glad everything turned out alright. These are the first years after all uh...things will get better in the long run.
on Jan 22, 2007
Glad everything worked out with the furnace. That is scary stuff.

It sounds like when you get down time, it is certainly well deserved. Chaos is an understatement.
on Jan 23, 2007

These are the first years after all uh...things will get better in the long run.

Heh, yeah, we'll see.  Things will surely get more crazy before they get better though.

It sounds like when you get down time, it is certainly well deserved.

It is certainly welcome when it comes.

I think its absolutely disgraceful the way doctors are trained, ridiculously long shifts, no time off, and a workload that would drive anyone mad. I know you do the best you can, but I often wonder how much patient care suffers due to the mistakes of exhausted interns?

I can see where you are coming from LW.  But at the same time, I have to ask what they solution is?  I wrote some more in depth thoughts about this here, and honestly don't see a good solution.  Honestly, the only way to decrease the amount of time we work is to do the following:

1) Double the number of physicians: This would require either doubling the number of medical schools or doubling the enrollment at the current medical schools.  Either of these require doubling the teaching staff, greatly increasing teaching area (in terms of physical facilities) and increasing the number of medical facilities at which students train.

2) Double the length of residency: There is simply no way you can be a competent doctor in the current number of years that residency is if you cut your hours any more.  It is impossible and would be very unsafe.  Take, for example, a surgical residency.  My residency is 6 years.  Were I to decrease the number of hours I work I would have to similarly increase the number of years.  Now my residency is 10-12 years.  That means it is longer before I am able to really start paying off student loans, and effectively shorter time I am able to actually practice medicine.  Oh, and #2 is going to directly make #1 much, much more difficult to achieve. 

So we are stuck.  We either work with the current system as best we can, or we completely revamp the entire system.  Personally, I'll work with the current one.

on Jan 23, 2007
I think the missing piece in the equation are the attending physicians. If yours were not a teaching hospital, they'd be doing all the work. I noticed that to maintain residency training accreditation, hospitals in the U.S. have to abide by certain standards.

I know that time is short and the feeling of servility is great, but do you need to form an advocacy organization at the local level? This organization could have information-gathering as its primary function, with an annual report to the accreditation agency. There is no way those attending physicians would want to lose their pampered status. Just a thought.
on Jan 23, 2007

Not that you have much choice!

I guess what I am saying is I think it is about the best choice there is.  In weighing the pros and cons, this is probably the best we can get.

I know that time is short and the feeling of servility is great, but do you need to form an advocacy organization at the local level?

I don't know what there is to advocate though.  At least here at Dartmouth, they are pretty good about making sure we are not abused.  They are very strict about us not working over hours (to be honest, most of that is they don't want to get in trouble from the RRC), and treat us pretty darn well.  I'm busy, but for the most part, I'm happy. 

on Jan 23, 2007
I'm happy

Understood. My secret's out, I'm a care-taker. After a few years, it gets in one's blood and one starts running around trying to save everybody, regardless of their situation. One thing I learned in family therapy, that I need to remind myself of from time to time is the following. When someone tells you about a problem, always ascertain whether it is for 1)information, 2) discussion, or 3) help. I go for number three often automatically.  
on Jan 23, 2007

When someone tells you about a problem, always ascertain whether it is for 1)information, 2) discussion, or 3) help. I go for number three often automatically.

I get the same way myself.  My wife always accuses me of trying to be a mechanic too much.  In the end it is true.  I think that is what the draw of something surgical was: find a problem, go in and fix it (or try to at least).

But I appreciate the suggestions.  Last week was something of an anomaly.  We just happened to be a few men down, so things sort of hit the fan.  This week is much more tranquil, as evidenced by me having time between D/C summaries to write a tad here.