Monday, January 25, 2010

Call Weekend


6:00 a.m. Wake up, shower, and get out of the house before the kids wake up. I can't bear feeling guilty for leaving all day on a Saturday.

7:15 a.m. Get to work. Thank goodness, only three new marrows. I still have three hanging over my head from Friday. Triage the marrows and three nodes, order special stains and flow cytometry. I want to have this behind me before I take a break for coffee and breakfast. Stop by and ask the Saturday transcriptionist if she wants anything from the doctor's lounge. Can't offer her a hot meal - there's only yogurt, bagels, and cold cereal on Saturday. She seems pleased to get a bagel and yogurt. I pile on the cream cheese and add honey.

8:30 a.m. Settle down for a day's work. Notice, on the way back from breakfast, that one of my partner's light is on. Quickly work up my new acute leukemia so I can show it to him and get him to concur with my diagnosis before he leaves. He agrees with my classification, and I release it so the oncologists can begin treatment. Become slightly frustrated that the only name on the requisition is a family doc who isn't taking calls until noon. Spend 30 minutes tracking down an on-call oncologist. This is a serious diagnosis. Her marrow is being replaced with leukemic cells, and I notice her platelets are dropping exponentially. Someone needs to know.

9:30 a.m. Start getting notification from the blood bank about a problem patient - tough antibody work-up. They are getting pressure to gather 16 units to prepare for a possible heart transplant later on today. Her blood type and antibody work-up demand resourcefulness. Donor hearts don't come around every day - we need to be ready.

10:30 a.m. Show the on call anatomic pathologist a giant granuloma in one of my bone marrows. I learned from the clinician notes that she is worried about metastatic cancer, or lymphoma. All I see is a granuloma. "Would you call this caseating necrosis?" I ask. He said, "Well, it is definitely necrotizing. I wouldn't get hung up on the type of necrosis. Just get the bug stains, and look carefully. I almost missed an atypical mycobacteria last week." I thanked him. Necrotizing granulomatous inflammation.

12:00 Heat up a spicy black bean burger and take a 15 minute break. Surf around in my google reader and facebook. Become pleasantly surprised that one of my good friends made a post, a few minutes ago, on a weekend. Read it and laugh. Return an e-mail from Friday night. Close my laptop.

12:30 Spend the next 2.5 hours finishing what I can, with the flow and stain results rolling in. Work fast. Sicily was invited to a birthday party from 4:00-5:30, and I am determined to make it at any cost. We have been at this new school since last June, and I still don't really know any of the parents.

3:15 Leave work to gather Sicily and head over to Pink Bliss. Fraternize with the moms and dads while Sicily is getting her nails painted aqua and hot pink. Meet Abby's mom. Savannah's mom. Morgan's mom. Srilakshmi's mom. Tell little endearing stories about their children that Sicily has related to me at bedtime, over the year. Discuss kidney stone problems, with a mom. Delightfully run into John's teacher, who I didn't realize had a kid in first grade - I knew Sicily was her friend but mistakenly thought she was in Kindergarten. Bask in her compliments of my son.

6:00 Pick up take-out sushi to bring home for dinner.

8:30 Head back up to work after book and song time with the kids. Clear out peripheral smears and put the finishing touches on tough cases. Thoughtfully dole them out to partner's boxes for consult on Monday.

10:00 Scare the bejeezus out of two nighttime histo techs trying to say hello on my way out the door. Laugh and talk. Drive home.

10:30 Trying to veg out to music on the internet, when I get paged by the transplant cardiologist. The tough antibody work-up, from this morning. They are going in to harvest the heart, and plan to transplant around 2:30 or 3:00 a.m. He is giving me a heads-up on a desired apheresis treatment as soon as the patient gets back to the CVICU after post-op. I nail down as many logistics as I can, realizing that all of the lab values I need to plug into my formulas for plasma exchange will probably be altered drastically post-surgery. The cardiologist can't decide if he wants to replace her with albumin or FFP - fresh frozen plasma. He tells me that he will call me when she is stable, as early as 6:00 or 7:00 a.m. I alert the dialysis nurse on call. I am relieved to find out who the Sunday nurse is - she is very competent and I love working with her.

12:00 I go to sleep.

5:30 My alarm goes off. I don't want to miss the call from the cardiologist, and quickly check my bedside pager to make sure that I didn't miss a page. I lay in bed until my son John joins me at about 6:15.

6:30 John and I watch YouTube videos for a ridiculous hour. First, blizzards. I didn't realize there was a massive blizzard in 1977. I was John's age. I delighted to the radio recordings and the images from that time. We also watched a lot of videos of snow forts. Then we degenerated to anacondas. Eating hippos. Fighting crocodiles.

7:30 I lied and told John the battery was dead, on the computer, so he would let me get up and do coffee and breakfast. He cooked eggs while I heated the cheese toast. He insisted on setting a place for his sister, even though she was still getting her beauty sleep long after our food was ready.

8:30 I wake up Sicily and pop in a video so I can go run. My pager goes off. Time to coordinate the procedure. In between running, I spend time on the phone with the dialysis nurse, the transplant cardiologist, the CVICU nurse, and the blood bank trying to make everything a go by noon. I also arrange for childcare so I can be present for the procedure. I am busy, but happy that the patient made it through the surgery. And happy that I squeezed in my run.

11:15 Drop the kids off at my parents and head to the hospital. Introduce myself to the transplant cardiologist and the CVICU nurse, who feel like family after all the questions and logistics we have worked out together over the past 16 hours or so. Give a thumbs-up to the dialysis nurse, who is gloved and gowned in the sealed room. Everything is going great. Double check all the labs and calculations on the computer in the CVICU. Write notes. Firm up future plans for additional procedures, to notify the blood bank. Turn in the billing slip.

1:00 Get to my parents in time for wonderful Mexican and a large round of the German version of Uno. It's called Solo. It's a lot crazier.

3:30 Take kids home, play fort, clean house, cook dinner, and settle them into bed. Crash. Look forward to tonight, a post-call Monday.


christie said...

Wow! I'm exhausted on your behalf! And to think I was feeling sorry for myself for teaching five straight hours yesterday! Glad you survived. And Glad I was a small part of your day! :) I want to play Solo!

Gizabeth Shyder said...

You had to work on your birthday?? Inhumanity. Torture. I quit working on my birthday last year - mainly b/c I got so many phone calls I couldn't get any work done and was ending up working late. Much better to have birthday off.

Solo was so nuts - trading hands, drawing four with a wild card, etc. I still am not sure about all the rules. I was teasing my mom that she made some up.

ts said...

omigod!! that was a busy call weekend!

Gizabeth Shyder said...

I am the only female partner left, currently, that takes CP call. One of my partners gave it up two years ago, another one year ago, and a third a couple of weeks ago. That was a rather tame call weekend, actually. It can be rough. Luckily, Brentie wants my call when I make partner this fall:) Maybe I'll give him some:)