Running in the rain

Another afternoon thunderstorm rained on the city today. Traffic crawled down the expressway on my way home, but fortunately I knew a little shortcut that bypassed a good 3/4 mile of traffic! And even though I'm post-call, I wasn't that tired, so I decided a quick afternoon run would be just the thing. Although it was nice not being drenched in sweat, being drenched in rain still leaves me drenched...

I had quite a few cross-cover calls during the night. One of the first one caught me in the dead of sleep, around 1:00 in the morning. "Doctor," the intense nurse began, speaking quickly, "the patient's Calcium Gluconate was written for 50 mg/hour, and the dilution leaves it at 1 mg/cc, but the fluid has been running in all day at 4.5 cc/hour, so should I run it as ordered at 45 cc/hour, or continue as it's been at 4.5 mg, could you please clarify?!?" I felt like I'd been awakened by a story problem: If a train leaves Chicago heading due east at 80 km/hour and 2 hours later another train leaves Pittsburg heading due west...

An hour later, another page came. This time, the ICU was calling. The nurse taking care of my intubated patient began explaining that his O2 saturation had been dropping and they were having trouble keeping it up. I was a little confused what his question was, until I asked, "Would it be helpful if I came down?" and he answered, "Yes!! Please do!" Even though this took nearly 45 minutes in the middle of the night, it was one of my first opportunities to work through a good differential diagnosis for shortness of breath in the acute setting. I ended up diuresing the patient for a volume overload state, but the lower extremity dopplers in the morning showed bilateral DVT's (deep venous thromboses), even though the patient is on prophylactic blood thinners. Even with my lack of experience and still young sense of intuition, it was satisfying to be able to take care of a patient simply by virtue of being there.