I’m at the point in my internship that taking overnight call on the inpatient floors is more of a chore than a challenge. We admit patients, and field a few dozen nursing pages that are usually manageable. I walked into call yesterday with my 95 year-old lower lobe pneumonia patient rolling into atrial fibrillation with a rapid response rate of 180. For some reason her blood pressure was also elevated to the 180′s systolic, which isn’t as common in a-fib. The kicker was that she wanted to be full code. Great.

As I was ordering a diltiazem push, an ICU nurse had materialized at the scene–apparently the floor nurses called a rapid-response code (RRT) behind my back. RRT codes are usually called when a patient needs of prompt attention when housestaff aren’t available immediately. I was, however, already at the scene. No time for hurt feelings though–I was glad that help had arrived, especially since my senior resident was nowhere to be found. My brain had already closed down to internal medicine knowledge, as I’ve since mentally moved onto starting ophthalmology residency.

Soon afterward, a cardiologist arrived to evaluate her. We transferred the patient to the ICU later that morning, and started her on a diltiazem drip. She stabilized for the next 12 hours until the evening rolled around. She then became delirious, pulling out her lines, jumping out of bed, and muttering nonsense…all typical of ICU psychosis. As I was redirecting her back to bed a third time, she decompensated, and spiraled down to a rapid heart rate again. She further deteriorated and required intubation.

Daytime soon rolled around, I signed out to the day team. I now have a 95 year-old woman on a ventilator. Great. I wonder what other excitement will be had when I come back on Monday…

medicine medicine