A Week In the Life

The schedule in the MICU is a bear. My team consists of myself and my intern Ali, and we're on-call every third night--each call being scheduled as a thirty hour shift. Every third day either myself or Ali has the day off (so each one of us gets every sixth day off). As an example, the week for me has been the following:

Monday: "good day" (worked from 6:30am-5:30pm)
Tuesday: on call (came in at 7am, left the next day at 1:30pm)
Wednesday: post call (leave at 1:30pm)
Thursday: day off :)
Friday: on call (came in at 7am, left the next day at 1:30pm)
Saturday: post call (leave at 1:30pm)
Sunday (today): "good day" (worked from 6:30am-present--I am looking to get out of here early today, probably 4:30pm).

In general we're pushing the maximum of the work-hour rules (about 3 years ago the ACGME, which oversees all the different residency programs in the United States, decided to institute work-hour rules reform in response to a particular legal case involving a medical error made by a resident who had been working an absurdly long shift), which is defined as 80 hours a week or less and no shift longer than 30 hours. By the calculation above, looks like I'm at 82 hours a week and our call shifts are 30.5 hours, so by and large it looks like we're more or less in compliance.

Last Friday night on call was one of the worst...our team had three different deaths! Two were expected and one was not--a new admission with Alzheimer's disease who became severely septic, went into florid DIC (a form of craziness in the blood that affects the clotting factors), and spiraled out of control rapidly. There was also a cardiac arrest by one of our long-timers in the MICU (I think it was his fourth "code" during this hospitalization, an indication of his severely ischemic heart disease and reflecting his overall poor chances of making it out of the unit alive). He remarkably pulled through after about 12 shocks, multiple rounds of epinephrine, and is still with us this morning. Our team also achieved a moral victory when a young woman of 24 years of age with liver failure that had been with us for about 2 weeks and was at death's door remarkably obtained a liver transplant at the last possible minute...there are occasionally some good stories here!

I saw the movie "Fantastic Four" last night on pay-per-view...it was a lot better than I expected, even with the multiple deviations from the standard plotline. It did a good job of tackling the complicated family dynamics of the FF, and also I was also tickled to see Stan "The Man" Lee's cameo as famous Marvel mailman Willie Lumpkin.