Sugar: Day 2
Again the disorientation of being pulled from a deep sleep. Again grabbing the wrong device. Pressing the button on the beeper does nothing to the grating noise and I eventually realize it's the alarm. I so wanted to sleep. Just sleep.
The rule post-call is "Keep moving".
Brush teeth, keep moving. Shower, keep moving. Any pause, just sitting for a minute with a cup of coffee, can cause a resurgence in the barely suppressed need for sleep. I drive in to the doctor's lot and shut down the car. For a moment the battle is lost and I go out in the driver's seat. A door slamming across the lot brings me around and I head for the hospital.
Up the stairs to the third floor and into the unit. I greet the HUC (stands for unit coordinator or some such) with the standard "Good morning! Who died?". '
"None of yours, Doc."
I slide into the chair before a computer and log in to the clinical information site. While my list opens with impossible slowness I glance into Room 355. The young diabetic is still there, restraints on the arms, endotracheal tube (ETT) in place, vent sighing and alarming, monitor traces blinking and alarming.
The labs have gone from incompatible with life to just grossly abnormal. That's a start. I go to the room and begin my exam. Still unresponsive but the pupils are reactive and C, the nurse, tells me he's been agitated at times. Actually a good sign in this case as it suggests he hasn't totally cooked his brain. I check the drips and their respective pumps, and review the flow sheets. Things look pretty good in fact and I can feel the weight of the Angel fade. Always that low, non-human chuckle and the feeling of shadow passing. It talks to me sometimes, but not today. I smile as I write my progress note and new orders. "Get over it Angel! This one is not dying, not on my watch."
The family files in. Today they seem less hostile, even sympathetic; perhaps in recognition of my being here again bright and early this morning despite an obviously sleepless night. Perhaps also in recognition that things are better and their boy will live. The mother is smiling a little, her questions more gentle. I sense the father wants to hug me and so begin sliding from the room.
The scene as I leave is orderly. The boy is still critically ill but the Angel of Death has given up. Orderly.
I have often felt that practicing critical care medicine is about creating order out of chaos. The ICU doc is compulsive and repetitive, checking again and again, not because he's neurotic, but because it holds back the darkness, holds back the Angel of death, creates order where once chaos ruled.
The rule post-call is "Keep moving".
Brush teeth, keep moving. Shower, keep moving. Any pause, just sitting for a minute with a cup of coffee, can cause a resurgence in the barely suppressed need for sleep. I drive in to the doctor's lot and shut down the car. For a moment the battle is lost and I go out in the driver's seat. A door slamming across the lot brings me around and I head for the hospital.
Up the stairs to the third floor and into the unit. I greet the HUC (stands for unit coordinator or some such) with the standard "Good morning! Who died?". '
"None of yours, Doc."
I slide into the chair before a computer and log in to the clinical information site. While my list opens with impossible slowness I glance into Room 355. The young diabetic is still there, restraints on the arms, endotracheal tube (ETT) in place, vent sighing and alarming, monitor traces blinking and alarming.
The labs have gone from incompatible with life to just grossly abnormal. That's a start. I go to the room and begin my exam. Still unresponsive but the pupils are reactive and C, the nurse, tells me he's been agitated at times. Actually a good sign in this case as it suggests he hasn't totally cooked his brain. I check the drips and their respective pumps, and review the flow sheets. Things look pretty good in fact and I can feel the weight of the Angel fade. Always that low, non-human chuckle and the feeling of shadow passing. It talks to me sometimes, but not today. I smile as I write my progress note and new orders. "Get over it Angel! This one is not dying, not on my watch."
The family files in. Today they seem less hostile, even sympathetic; perhaps in recognition of my being here again bright and early this morning despite an obviously sleepless night. Perhaps also in recognition that things are better and their boy will live. The mother is smiling a little, her questions more gentle. I sense the father wants to hug me and so begin sliding from the room.
The scene as I leave is orderly. The boy is still critically ill but the Angel of Death has given up. Orderly.
I have often felt that practicing critical care medicine is about creating order out of chaos. The ICU doc is compulsive and repetitive, checking again and again, not because he's neurotic, but because it holds back the darkness, holds back the Angel of death, creates order where once chaos ruled.
posted by ICUDOC at 8:19 PM
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