I'm sitting in my call room at 1 AM here at the hospital. It's been a non-stop day since I arrived here at 6:15 AM. Dr. O. told me this morning he had worst call night he's had in three years of being a surgery resident. The greatness has continued throughout the day. I didn't stop to take a breath until right about now. However, I'm not complaining whatsoever. I'm actually having a great time, and I'm learning A LOT! Dr. Tidswell is in charge tonight, and he has been exceptionally informative and pleasant. Dr. Perez has also been on his a-game, as we've discussed several topics, most notably the portal venous system (which is basically the blood flow from the intestinal track and spleen to the liver...look it up).

I have amazing patients tonight--one who was shot through the brain and is still living. He is proving to be a challenge, but I think we've stabilized his intra-cranial pressure for the time being. There is no way to know if he will ever recover, but at least he's still alive for now. At least he has a chance which sometimes is all we can ask for in the ICU. I also have a patient who had his portal vein, splenic vein, inferior mesenteric vein, and superior mesenteric vein tied off. I'll explain how difficult a situation that is at a later time. Right now we're just trying to keep the patient alive until his surgery to fix all of that this morning. A also watched a young girl of around 33 years die tonight. The medicine team's attempts to resuscitate her with CPR and heart boosting medications were not enough to bring her back. It was a very emotional situation as the boyfriend was there in the room encouraging his girlfriend to pull through, but it just wasn't to be. This job will certainly be full of ups and downs. There are plenty of ups to speak of as well. I have become friends with a patient who has been here longer than I have. His wife is delightful and I can't wait to tell her that her husband will be transferred out of the ICU (hopefully) tomorrow. That will be a great moment for me, as this patient has really struggled for about a month now, enduring complication after complication. I think he's finally in the clear, and nothing will be more gratifying than to send him to the regular patient floor. I also had lengthy conversations with two of my other patient's families tonight. Being on-call affords me the time to spend with families, which is also very gratifying (for them and me). I get no better pleasure to explain things to the patient and family...especially if the news is good or encouraging. There was plenty of that tonight, mixed with the bad as well.

So this surgery thing is going to be a game of ups and downs. Hopefully the ups will outweigh the downs as I move forward as a surgeon. Things are looking great so far...

I know I haven't been updating this thing like I should, but hey I have a real job now. Free time isn't the name of the game these days. I'm actually sitting in the ICU staring at a bunch of monitors, rooms 17-24, a doctor on the phone, several nurses running around, an ICU pharmacist, a few technical assistants, and of course the patients. There is a lot of beeping, blinging, chirping, overhead paging, hallway conversations, laughter, phone conversations, footsteps, chairs shuffling about, several different television stations emanating from the patient rooms, a radio with Billy Joel's "Piano Man", and even the sound of oxygen originating at the wall and ending up in a patient's lungs. I have always thought one could write a symphony of ICU sounds. Actually, I'm sure someone has probably already done this, as I can't believe I'm the first to think of such a thing. The ventilators are the best, as musical tones will alert the staff if the machine becomes disconnected or if the patient stops breathing. It's really quite an active place. Interestingly enough it can also be very tranquil and quiet, especially at night. Actually, since I started writing this it got very quiet. Funny how so much can become so little.

It's just about midnight here on the East Coast. I'm waiting for a patient from the OR to arrive after having his aorta fixed. Apparently he has metabolic acidosis mixed with respiratory alkalosis. I get to fix it. I have about ten hours left of my 30 or so "on-call" hours. This would be my first call ever as a physician. Of course it's in the ICU where the "24 sickest patients in Western Massachusetts" (as one physician put it) are tonight. It's been interesting to say the least. My attending is an incredible teacher and very pro-resident. The fourth year surgical resident is also incredible and TEACHES all the time. He is like a walking medical encyclopedia, just like my attending. I really have every reason to learn a ton this month. I hope to finish with a solid critical care foundation.

The ICU is an interesting place. It was a "slow burn" of stuff to do all day. It wasn't too busy and certainly wasn't boring. However, things got interesting about an hour ago. One patient's heart rate began to rise while his blood pressure fell. Plus he was bleeding out of a wound, which was freaking me out. I ended up having to stop medications, hold medications, give him fluids, fix his bleeding wound, and at the same time answer pages for my other patients. While all this was happening, one patient with a brain injury started breathing sixty times a minute. However, the nurse and I got that under control as well. You really can try anything you want here to make the patient better. There isn't a handbook for me to read, and there isn't anyone holding my hand. Add fluids, stop fluids, more morphine, less ativan, check a hematocrit, give a lactated ringers bolus, check potassium and sodium, what's his temperature, what's the pTT, who's the nurse, when is the patient's CT scan, check a hemoglobin...it's one tiny crisis after another. However the bottom line is it's fun. (Does that make me crazy?) This is the ultimate problem solving game. You think fast and you think clearly or you might hurt someone. I'm surprised how calm I've been under tremendous pressure. Yet I realize this is nothing. Just wait until I'm on trauma or in the OR when things go sour...that will be the true test of nerves. I'll literally have people's lives in my hands. It certainly gives me a great deal of respect for surgeons. I hope to one day earn that respect from others.

This is for Dr. Brian O. who is working hard saving the lives of the sickest patients in Western Massachusetts. It is said that rubbing the Buddha's belly is good luck. Hope the call night is going well!