Monday, June 22, 2009

It's got to be hard being the "on-call" doc

James was admitted one day before I was blessed with him on my assignment. He was a 70'ish year old man with a very distended and firm abdomen. He was scheduled for a colonoscopy the next morning so I had the previledge of administering the bowel prep. He was sitting up in a chair with his wife, son, dauhter-in-law, granddaughter and grandson visiting him , when I started my shift. I quickly went in did my assessment and got out, giving them time to visit and giving me time to see my other patients before I would be busy with this bowel prep.

He had been having a little trouble breathing when he was in bed because of the pressure from his belly. So sitting up made him feel better. I explained what the evening was going to consist of and told him I would be back in about an hour to get everything started. He had already been drinking miralax so we were well on our way with the easy part of the prep.

About an hour later I came back and was going to talk to him about the timing of the enemas and how much miralax he still had to drink, but I was incredibly distracted by the wheezing and coughing I heard from him. He had not been doing this when I was in the room an hour earlier. His face was flushed and he was freezing. His wife had 4 blankets on him.

I helped him back to bed, raised the head of the bed up so he could breath better and took his temp. . . 101.9! Great! I asked him about the wheezing and couphing and he said he just started that. I listened to his lungs and they did sound a little wheezy too. He was NPO (nothing by mouth) so all I had for the temp was a tylenol suppository. So we postpone the enema (x2) that was supposed to be the next part of the prep, and go straight for the suppository. I called the doc about the wheezing, as he also had a heart history, and I was a little concerned about fluid overload with the fluids they were giving him. We ended up with a chest xray that came back clear, and respiratory treatments.

I no more got that order written and sent to the pharmacy, that I hear his pulse oximenter beeping. His oxygen had dropped to 82%. . . and he was already on 3L of oxygen. I called the RT (respiratory therapist) to get the neb treatments now, and put him on a 50% venti mask.

Poor guy, stayed on a venti all night long. I can't even begin to tell you how many times I called that doctor. I felt so bad for her, calling in the middle of the night but I really didn't have alot of choice. She was the one on call. However she was not the doc that had been seeing this patient, so we did alot of conversing and putting our heads together to keep this guy comfy through the night.
One of the times I called her was for a critical lab. His INR was way high. So high that I knew they would surely cancel the colonoscopy scheduled for the morning. Then by 6:00am (my shift ends at 7:30) his blood pressure was dropping. I had to call her yet again, because it was below the call orders. I also inform her that this patient has been getting fluids all night and has not urinated. We did the enemas, but had no results, and his belly is bigger than it was when I started my shift, AND his face is a little puffy, and his arms are a little puffy (they weren't this way to begin with). By this time the wife is getting a little freaked out. The on call doc simply said, Dr. Surgeon (who was his admitting doc) will be in in a couple of hours. See what he wants to do.

I go to inform the wife that I am sorry, we will have to wait for Dr. Surgeon to get here. I let her know that the on call doc said Dr. Surgeon should be here early. She thanked me and seemed ok with this information. I however felt terrible, my gut knew something was not right!

What I wanted to do was stop the fluids, sink and NG and get it hooked up to suction, anchor a foley and give the man some lasix. But of course I am just the nurse. . . . I had to trust Dr. OnCall and wait for Dr. Surgeon to get there.
I reported off to the day shift nurse and told her all my concerns. She then informed me that Dr. Surgeon is NEVER there before 10AM and since this is a weekend, it would probably be later. I then asked if there was someone else I could call before I left to try to get something done before I clocked out. She just looked at me with this really dumb look and said, "No, but thanks." She really didn't appear that concerned about anything I had told her.

I worried about this man all the way home. I went to sleep and woke up to get ready for my next shift still with him on my mind. Wondering what was done and was the nurse attentive enough, proactive enough, to take care of him.
I didn't work that same floor that next night. However what I learned was that the colonoscopy was in fact cancelled and Dr. Surgeon didn't come in until around 11 and took him straight to the OR. I am assuming they did a bowel ressection, but I have not heard that. Last I had heard, he was still vented in ICU. As soon as I heard the news, I went to the ICU waiting room to see if his wife was there. She never left his side since the day he admitted so I thought maybe she would be sleeping in the ICU waiting area. She was no where to be found. When my shift was over, I stopped by the ICU waiting area again, and still was unable to find her.
All the way home that morning I prayed for him to recover and for his wife to have her husband back at home with her. I have thought of them several times since then. They were a very sweet couple and I felt so bad for them and what they were enduring that particular night.

I never did fine out what the outcome was with James. This is the part of the job that is hard. I have to care for them and let them go. However there are so many that I can't let go of. They remain with me as a gentle reminder of why I love my job. This is the part of my job where I learn to have faith in God, knowing that He will take care of these people. Either way. . .



  1. My Mom is a CNA in a hospital, and says that it is a very hard and emotional job sometimes!

  2. You go girl! Awesome assessment! It is hard leaving, worrying and wondering. Oh,BTW, I tagged you. Drop by Mops and Pops Place if you want a challenge... :)

  3. Otin, I would agree. I was a CNA for over 10 years in long term care before I became a nurse. It is a hard job!! AND it is the CNA's at the hospital that work really hard. They are the ones who make it possible for the RN's to really do their job.

    Southern Drawl - Thanks! I did get the tag and took you up on your challenge!!!

  4. okay, I love you. That's it. I volunteer in the ER of an emergency room here in L.A. and so many people pass through our doors and I have no idea what happens to them. I just hope I made their stay a bit easier. Please come back and see me again b/c I will be back here to see you. I am subscribing now.

  5. bernthis - thanks for coming by!! I so admire those that volunteer at hospitals. That is not always an easy job to have. And I so appreciate the volunteers we have. Thanks for giving of yourself in this way! I am sure you touch more lives than you really know. I will definately be back to your blog!