nurse | Elbrecht's Corpuscle

Black Betty

Posted on April 23, 2016 by Elbrecht

At 2:17AM on a recent Friday morning I couldn’t sleep.

Not in the sense that I was laying awake in bed, thinking about the cosmos, or wondering how “The Walking Dead” Season Finale would play into any future cross-over series that might be developed, or anxiously awaiting the sun to rise again.

I was actually physically not able to sleep.

As my body was beginning to shut down at the cellular level, the efflux of potassium and phosphorus from every cell beginning to overwhelm my blood stream, the pager holstered upon my left hip started chiming again.

The pager transmitted electrical energy, similar to that of a defibrillator, into my body; the potassium and phosphorus blasted back into the cells, preventing a super-saturated metabolic derangement which would have caused my cardiac activity to cease.

Simultaneously, the loudspeaker in the Emergency Department blared, “Septic Shock Alert, ED 47.”

“Septic Shock Alert, ED 47.”

I unholstered the pager from my hip, quicker than Doc Holliday when he penetrated Ringo’s brain with a lead slug, and glanced down at the message awaiting me.

As I swiveled and rose from the stool I had been atop for only a matter of moments, I read the message. Thankfully, it only read “Septic Shock Alert, ED 47”, the electrical companion to the overheard communication, instead of 555-9095.

Or 555-9030.

Or 555-9494.

Those numbers belonged to the Hospitalist medicine service, the Intensive Care Unit, and the ED Nursing desk, respectively.

Responding to any of those calls would have meant either another patient was waiting for me to admit them to the hospital or an already admitted patient was trying to die in the ICU.

If any of those three numbers had been present, I would have needed to take over the care of the actively dying patient in the Septic Shock Alert, while simultaneously trying to:

1) figure out how in god’s name I would possibly get all of the work done I still had to do

2) supervise my junior resident

3) not lose my mind.

I also probably would have taken the pager and rifled it into the closest wall, hoping to have it explode in a wave of energy like the Death Star in Episode IV.

My Junior Resident sat beside me, near catatonic from Night Call’s siren song; I tugged at his scrub top, motioned for him to follow along, and let out a long sigh.

I could not sleep.

I was the Senior Resident on Night Call.

Or as I prefer to call her, Black Betty.

Black Betty is the anthropomorphic representation of Night Call, the overnight shift when physician staffing drops to a skeleton crew and the statistical probability of all hell breaking loose starts creeping up on 100%.

As the sun begins setting on a hard day’s work for most of the physicians, nurses, and ancillary staff in the hospital, Betty begins to rear her ugly head.

Her darkness requires the fortitude of a special type of physician.

Unless you are a Resident like me. Then you are required to show up to spend some time with Black Betty as a part of your training.

You are not a special physician. You are a Resident. And the only thing special about you is your ability to not spontaneously combust from the lack of sleep you have sustained.

Every Resident dates Black Betty. Some for a night here and there, with no specific frequency or expectation. She does not discriminate.

Others join her for a two week stretch; where her smooth skin becomes chapped and dry by the third night, her velvety caressing hands become stiff and arthritic by the seventh, and her formerly gentle kisses become vicious flesh-tearing wounds as the sun rises on the tenth.

Black Betty invites the denizens of the night to start shuffling into the Emergency Department.

And the critically ill whose lives are sustained by technological marvels in the ICU to begin their physiologic derangements.

They are joined by the sickly and elderly who become unpleasantly delirious as a result of her rancor.

—–

To this point in my Residency, I have spent over 20 weeks with Black Betty. A majority of those weeks have come in two week chunks, spread over In-patient Medicine, Surgery, and Obstetrics.

But as a now as a PGY-2, the Senior Resident, I have also had more than my fair share of random Saturday date nights with ‘ol Betty.

She and I have been intimate more times than I would care to admit.

Each date brings about something unique, whether it’s a patient hurtling a chair through a 7th-story window, a near-dead woman’s heart beating in full view of the audience in the trauma bay, or stabbing a needle into a man’s chest to hear the whoosh of air escape and provide his lung the opportunity to re-inflate.

She is fertile with opportunities for us to perform our duties as physicians.

Black Betty had a child, the damn thing gone wild.

dont-scare-your-kids

At 2:43AM on a recent Friday morning I exited ED 47 with my Junior Resident in tow.

Black Betty had provided us an opportunity to exercise our clinical judgement, initiate resuscitative measures, and stabilize an elderly gentleman who had tangoed with the Grim Reaper several times in the past two months.

The Reaper’s grasp had tried to choke off the man’s air supply. But we would have none of that.

Black Betty didn’t care. She shrugged it off.

She knew other opportunities awaited.

And my Junior Resident and I would be there. Waiting.

I would not sleep.

Not when Black Betty has anything to say about it.

Life Sustains Us

Posted on May 3, 2015 by Elbrecht

—–

Part of the training to become a Family Medicine physician requires the Resident to have the ability to successfully assist a woman in the delivery her child. Depending on your religion, culture, and/or understanding of human biology, when the baby exits the vaginal canal and lets out its first cry, its life has begun.

Being a part of this experience has led Family Medicine to adopt a credo of “from the cradle to the grave”, as we have the unique blessing to care for patients from the beginning of life until death becomes us.

Nearing the end of my Intern year as a Family Medicine physician, I have now had the opportunity to train as a physician on the Obstetrics and Gynecology (OB/Gyn) service two times. The first four weeks occurred in the first half of my year and were a whirlwind of stress and re-introduction to a field of medicine which I had barely survived as a student.

—–

During those four weeks, I constantly found myself on edge, not only because of my experiences as a student, but because I found myself as the least seasoned member of a team responsible for making sure each and every baby let out its first cry.

While a sense of relief and pride would wash over me when each baby boy or girl let out its first little squeal, most often while I was still holding it in my gloved hands, I was still tasked with several steps to assess the health of the mother after handing off the baby to the pediatrician who stood awaiting my delivery.

—–

Those additional steps were the cumbersome parts I would rehearse in my head while staring intently at the woman’s vagina as I used my fingers to create the space needed to assist the baby’s head from tearing perineal tissue. Often times, my mind would go blank as soon as the baby made its way into my arms.

After what seemed like an eternity, which properly calculated only totaled 4-5 seconds, I would begin assessing the mother’s health, including any vaginal lacerations which may need repair, massaging the fundus of her uterus to determine the likelihood of a postpartum hemorrhage, and carefully tugging at the umbilical cord still attached to the indwelling placenta.

—–

Typically within 10 minutes I would have transitioned from the foot of the bed, having delivered the newborn and the placenta, as well as completing the necessary postpartum assessments, to clickety-clacking away at the computer to document the successful delivery.

—–

My second go-around on the OB/Gyn service was nearly identical in substance to the first four weeks: women of different stages of pregnancy coming into Labor and Delivery Triage to be told if they were or were not in labor, often requiring me to perform speculum checks and cervical exams; actively laboring women begging for epidurals and anxiously awaiting their newborn while I paid hawk-like attention to the monitors assessing fetal heart tones and uterine contractions; rounding before the crack-of-dawn on women post-delivery, assessing their postpartum needs; and imparting my seemingly minimal medical and clinical knowledge of Obstetrics and Gynecology to the even less-knowledgeable medical students I was tasked with teaching.

But while the substance of the second four weeks was nearly identical, my experience as a physician training in this foreign world was markedly different. By the time I showed up for the second-go-around I was a substantially different physician; it is utterly unconscionable how much things had changed in five months…

how much things had changed in me…

how much things had changed in me as a physician…

how much things had changed in me as a physician responsible for the care of a pregnant woman and her unborn baby…

how much things had changed in me as a physician responsible for the care of a pregnant woman and her unborn baby while being the leader of the medical team.

—–

Suffice it to say, it was an overwhelmingly different four weeks. And by no means was I the lone physician paying excruciating attention to the women and their unborn babies, as I was assisted/supervised by a 2nd or 3rd year OB/Gyn resident and Attending physician, but the knowledge and experience I acquired during the initial four weeks allowed me a level of comfort in my own capabilities that I had not anticipated.

The knowledge and experience in regards to the medical aspects of physiology, biochemistry, and anatomy involved in OB/Gyn were certainly at the forefront of increasing my comfort level, but it was actually my knowledge and experience of the other members of the care team that proved to be my greatest asset.

Not that other medical services in the hospital don’t have exquisitely trained nursing staff, but the OB nurses are in a class all by themselves… and if you don’t respect that, they will bury you. Bury you in a world of cervical checks, bleeding vaginas, and spasming uteri.

Think about that for a second… spasming uteri. It used to give me chills even thinking about it… but that was way back when… when I was still learning about how life sustains us. Now I know to give some gentle uterine fundal massage. And run the pitocin wide open.

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