Monday, October 15, 2007

To sleep or not to sleep

This was my black weekend (on call Saturday therefore no days off). It really wasn't too bad, we had an unprecedented one admission which came early in the night. At nine, I realized I had nothing to do, so guiltily went to my call room and laid down, pagers by my head, hoping that no admissions would come in--and none did! I still did not get to sleep, as I was paged continuously about issues. Most I had to go see the patient for, thankfully most of those ended up being nothing I couldn't quickly handle. A couple of the pages I could handle over the phone without even getting out of bed. So I spent much of the night in a half-awake/half-dazed state, getting up about every 30-60 minutes. Even without sleep though it was much superior to admitting people non-stop. There was one patient that was a problem throughout the night--he was persistently bleeding from his mouth and nose--most likely from a high flow nasal cannula. It looked a lot worse than what it was, and the nurses were getting a little tense, particularly after his O2 saturation dropped into the 20s. This however, is not uncommon for him, and he came right back into the 90s by the time I got to his room.

When I left the hospital, I thought that I would likely not need to sleep as much in the afternoon since I had had a peaceful night. Ha. I started dozing after I had lunch and went to bed a little before 2pm. I woke up and looked at the clock--it was 3:30am. I slept more until 5am when I got up--that's the first time that has happened to me, usually I get up for a couple hours in the evening. So my n=1 study seems to indicate that constantly interrupted half sleep is not as restful as no sleep at all.

My patient with heart failure, now improved, failed her swallow study. Was scheduled to get PEG tube (tube that goes into the stomach for feeding) last (I think) Wednesday, consents were signed. The anesthesiologist however, wasn't comfortable putting her under anesthesia without talking to the mother. Problem is that mom's a flake and it's impossible to get a hold of her. So the procedure was postponed until tomorrow. This morning she spiked a fever. She's fine, but anesthesia may not want to put her under. The biggest issue is that the only reason she's still in the hospital is that she is waiting for a PEG tube. Frustrating.


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