A Knight of the Road
One of my partners has a black cloud.
Which is to say, whenever he is on call he gets hammered with consults and admissions of super-sick patients. It couldn't happen to a nicer or more consciencious guy. He never looses his temper or dresses down the nurses, as opposed to your's truly who has on occasion been known to lose his temper. Dr. B. is truly a saint, and has been cursed with a black cloud.
My last two call nights have definitely been black cloud material. I worry I may have acquired a black cloud of my own. Maybe I should do some ritual or ceremony involving the burning of a clump of sage.
Friday night could have been a fluke. Three ICU admissions after 9 pm! Going from room to room, physical exam, iv's, central lines, arterial lines... Just a fluke. Then came Monday night.
Now, if I can have dinner with my family and even do some bedtime reading to my youngest while I am on call, I feel like life is good. So last Monday, when I got the page to our second ICU, about 25 minutes drive into the southern suburbs of Minneapolis, I wasn't too upset. The patient was from California, and had apparently driven to Minnesota to take part in a contract job that involves industrial waste removal. The police pulled him over for erratic driving, but somehow discerned that he was not drunk, just confused. They brought him to the ER where his blood pressure was 200/120 (normal about 130/75). The high blood pressure was cooking his brain, what we doctors call "hypertensive encephalopathy", which technically means cooked brain.
He told us his feet and legs had been swollen for about two weeks and he was weak and short of breath. He also had acute renal failure and severe anemia, and it turns out he was most likely bleeding into his lungs. Believe it or not, but this whole picture is a well recognized syndrome (syndrome = running together of symptoms) called Goodpasture's Syndrome. Dr. Goodpasture described the syndrome of pulmonary hemorrhage, acute glomerulonephritis (say it 5 times fast) due to an autoantibody attacking the blood vessels of the patient. A classic autoimmune disease in which the body's immune system loses the ability to distinguish friend from foe.
He needed plasmapharesis, which is a procedure sort of like dialysis. We place a large-bore, dual lumen catheter in a central vein and hook him up to a machine that separates the plasma and red blood cells. We give the patient back his cells and replacement fresh, frozen plasma, and pitch the plasma we removed. It's a way of removing toxic antibodies that apparently cause Goodpasture's Syndrome. Actually, the scientific rational is not too far removed from blood letting or leeches, dressed up in scientific jargon. Basically removing evil humors. I also added high dose steroids and planned for some cytoxan later in the day. Basically shutting down the immune system and the evil antibodies.
I set about placing the central line, and while I scrubbed, prepped, harpooned, the patient told me about his life. He lived in California, to the extent that he lived anywhere at all, with his girlfriend of twenty years. He traveled the country doing contract industrial waste removal and had done his share or drinking, carousing, smoking, etc. He was tall and tanned and wiry. He had the hard muscles of a guy who had never seen the inside of a gym or health club. When I harpooned his femoral vein his only acknowledgement of pain was a grimace, and a slight pause in his story of life on the road.
It was late and I was focused on work. While I was talking care of him I had two more patients roll into the ICU in various states of disarray that promised to take me the rest of the night to sort out. Black Cloud Central. But I wish I had had a tape recorder running. The Knight of the Road was telling me his life story at 2 am in a suburban Twin Cities ICU, a story that needed telling. I got the line in, the pharesis nurse did her thing, and I moved on. The next morning, one of my partners took over. Once I catch up on some sleep I plan to check up on him, see how it all works out.
Which is to say, whenever he is on call he gets hammered with consults and admissions of super-sick patients. It couldn't happen to a nicer or more consciencious guy. He never looses his temper or dresses down the nurses, as opposed to your's truly who has on occasion been known to lose his temper. Dr. B. is truly a saint, and has been cursed with a black cloud.
My last two call nights have definitely been black cloud material. I worry I may have acquired a black cloud of my own. Maybe I should do some ritual or ceremony involving the burning of a clump of sage.
Friday night could have been a fluke. Three ICU admissions after 9 pm! Going from room to room, physical exam, iv's, central lines, arterial lines... Just a fluke. Then came Monday night.
Now, if I can have dinner with my family and even do some bedtime reading to my youngest while I am on call, I feel like life is good. So last Monday, when I got the page to our second ICU, about 25 minutes drive into the southern suburbs of Minneapolis, I wasn't too upset. The patient was from California, and had apparently driven to Minnesota to take part in a contract job that involves industrial waste removal. The police pulled him over for erratic driving, but somehow discerned that he was not drunk, just confused. They brought him to the ER where his blood pressure was 200/120 (normal about 130/75). The high blood pressure was cooking his brain, what we doctors call "hypertensive encephalopathy", which technically means cooked brain.
He told us his feet and legs had been swollen for about two weeks and he was weak and short of breath. He also had acute renal failure and severe anemia, and it turns out he was most likely bleeding into his lungs. Believe it or not, but this whole picture is a well recognized syndrome (syndrome = running together of symptoms) called Goodpasture's Syndrome. Dr. Goodpasture described the syndrome of pulmonary hemorrhage, acute glomerulonephritis (say it 5 times fast) due to an autoantibody attacking the blood vessels of the patient. A classic autoimmune disease in which the body's immune system loses the ability to distinguish friend from foe.
He needed plasmapharesis, which is a procedure sort of like dialysis. We place a large-bore, dual lumen catheter in a central vein and hook him up to a machine that separates the plasma and red blood cells. We give the patient back his cells and replacement fresh, frozen plasma, and pitch the plasma we removed. It's a way of removing toxic antibodies that apparently cause Goodpasture's Syndrome. Actually, the scientific rational is not too far removed from blood letting or leeches, dressed up in scientific jargon. Basically removing evil humors. I also added high dose steroids and planned for some cytoxan later in the day. Basically shutting down the immune system and the evil antibodies.
I set about placing the central line, and while I scrubbed, prepped, harpooned, the patient told me about his life. He lived in California, to the extent that he lived anywhere at all, with his girlfriend of twenty years. He traveled the country doing contract industrial waste removal and had done his share or drinking, carousing, smoking, etc. He was tall and tanned and wiry. He had the hard muscles of a guy who had never seen the inside of a gym or health club. When I harpooned his femoral vein his only acknowledgement of pain was a grimace, and a slight pause in his story of life on the road.
It was late and I was focused on work. While I was talking care of him I had two more patients roll into the ICU in various states of disarray that promised to take me the rest of the night to sort out. Black Cloud Central. But I wish I had had a tape recorder running. The Knight of the Road was telling me his life story at 2 am in a suburban Twin Cities ICU, a story that needed telling. I got the line in, the pharesis nurse did her thing, and I moved on. The next morning, one of my partners took over. Once I catch up on some sleep I plan to check up on him, see how it all works out.
posted by ICUDOC at 8:11 PM
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