Last week and for this next week, I am the night float on our service. I do the work of 3 people, except at night. My life is totally nocturnal–I sleep during the days and am totally awake all through the nights. I do this everyday. One of the problems with night float is that you cover many patients, normally covered by multiple people during the day. In my case, I am covering over 4o patients during the night that are normally taken care of by 3 people during the day. Of course, the night isn’t as busy as the day–not as much stuff can get done during the night. Unfortunately though, with that many patients, you’re bound to get a ton of pages for all sorts of random things. Nausea, pain, … V-tach. It can be painful. But I’m prepared for it. At least I think I am at the start of most nights. That’s where I usually go wrong.
What I hate most about the night float experience are the surprises. When I show up in the evening, I get signout from 3 people who are exhausted from a long day’s work. They want to get out of there so they fly through the events of the day. If something happened that may happen again overnight I will ask about it, find out more, etc.–is the patient ok? can this happen again? what did you do for it? did that work? what did work? who did you talk to about it?
This is good for me and good for the patient. This is not good for the person who is trying to go home. As a result, signouts go something like: patient x, nothing happened, doing great no worries; patient y, good day, nothing for you to do, etc. The problem is when I get a signout like: patient z, “his creatinine bumped a little, has repeat electrolytes pending tonight, shouldn’t be a big deal, just check on them, and, oh yeah, his pressure was a little low so I gave him some fluid. Not big deal, nothing for you to really do.” [As an aside for those of you who don't know, creatinine is a reflection of kidney function and the higher it is, the worse that the kidney function is]. The next thing I know (of course, 15 minutes after the day guys have left), I get a page that the patient’s blood pressure is now 65/40 (very low–not good), having mental status changes (i.e. acting weird, suggesting not enough blood to the brain) and now his creatinine is 3.5 (not good at all) with a potassium of 6.2 (rather high, making the patient susceptible to fatal arrhythmias). Oh, and did I mention the patient has a new oxygen requirement (needs supplemental oxygen–i.e. room air is not enough)? Yeah, not good.
I find that the night float resident is not too different from someone who goes out to buy a used car, while the day folks are the used car salesmen. “Oh yeah, no problems! No problems at all! It’ll run perfectly smoothly!” Uh huh. My example is not typical, but it happens. I wish you could blame the system but at the end of the day it comes down to apathetic residents who want to get the hell out of there and go home. After a while you get to know these people so I know what to expect. Then I still end up having to spend a decent portion of my night trying to find out what happened to these patients during the day so as to anticipate problems at night. It really irritates me. Don’t get me wrong, I want to go home too, but not at that expense.
In any case, time for sleep in order to get ready for the big game tonight: 45 patients, 4 of them are really sick, 2 of them could die–try to figure out who they are!
The life of a resident. Painful.