My poor circadian rhythms

I'm officially back to a daytime schedule now, following Saturday night's final overnight shift.

I arrived at 9:50 pm for my 10 pm shift start, and walked into CPR. One of the patients who'd had GI surgery several days prior had suddenly arrested. I assisted for about 10 minutes, at which time they called it off and pronounced the poor guy deceased. It was a surprising turn, since this particular patient had seemed to be improving quite steadily since his surgery. Everyone was, understandably, upset. Losing a patient really sets a gloomy tone for the rest of the night.

Other than the CPR, my shift was an uneventful one, with a mere 3 inpatients and no outpatients for which I was responsible. My 3 were familiar ones:

1. Mr. Presa Canario post-op Wobbler's surgery, here since Tuesday (Wobbler's patients typically stay 5-7 days in the hospital because they have a hugely extensive surgery on the vertebrae in their neck, and must be kept totally quiet for at least that period of time, which means we dope them up pretty heavily with IV pain meds and don't let them leave their cage for anything until at least 3-4 days post-op). Mr. Presa Canario is in need of an attitude adjustment (or maybe a breed adjustment) -- since he's started feeling better, he's become much grumpier and consequently more terrifying -- so his urinary catheter and IV lines were removed so we don't have to deal with those, and we pretty much do nothing with him other than feed him. He will have gone home yesterday or today.

2. Mr. Dachshund post-op hemilaminectomy, here since Tuesday. Poor Mr. Dachshund. Hemilaminectomy patients typically stay in the hospital about 2-3 nights after surgery -- 2 nights if they do exceptionally well after surgery, and 3+ nights if they are a little slower to recover. Most of them are still partially paralyzed when they are discharged (it can take up to 6 months to make a full recovery), but that's manageable for owners at home as long as the dog can urinate and defecate on its own. The problem with Mr. Dachshund is that he's had ongoing bladder issues since his surgery. Immediately post-op with all of these patients, we place a urinary catheter because we don't want to have to take them outside and we don't want them peeing all over themselves. Then a day or two post-op, we remove the u-cath and see if they can urinate on their own. If they can't, we see if their bladder can be easily expressed manually by placing pressure on their abdomen. If the dog is peeing on his own or can be easily expressed, he can go home. Unfortunately, neither is the case for Mr. Dachshund, requiring us to place a temporary urinary catheter several times a day to help him empty his bladder. I'm really hoping he improves in this area soon because he's going nuts in the hospital from boredom, and consequently driving everybody else insane with his whining and barking!

3. The older German Shepherd post-op hemoabdomen and splenectomy (patient #4 from Friday night). He's been doing somewhat poorly. His lidocaine infusion, meant to help control his cardiac arrhythmias, was making him terribly nauseated so we had to stop it. That meant that for the first 6 hours of my shift, his heart was all over the place -- his heart rate would rapidly jump from a resting rate of 55 beats per minute up to 150-200, all while he was sleeping -- and he had almost entirely ventricular-origin beats, meaning the electrical current controlling his heart was originating from the ventricles (bottom chambers) instead of near the atria (top chambers). At about 4 am, we started him on magnesium chloride, which seemed to help somewhat to increase the number of normal beats he had. Unfortunately, his arterial blood gas analysis in the morning showed that he was oxygenating more poorly in the morning than he had the night before, suggesting incipient pneumonia or something else happening in his lungs. He's such a sweet guy; I hope he improves soon.

We had a couple outpatients come in, but my rotation-mate happened to deal with both of them: a rat with a probable brain tumor that we ended up euthanizing, and a cat post-declaw whose owner felt she was very painful.

It appears that the weekend is the time for a lot of phone calls, which makes sense if you think about it -- on a Thursday night, people are probably more likely to decide on their own that something can wait till their regular vet opens at 7 or 8 am the next day, whereas an ill pet on Saturday night may not be able to see its regular vet until Monday morning.

My favorite call was a hoarse woman who sounded like a 60-year-old lady who'd smoked for 50 years. She called around 5 am to say that her toy breed dog had seemed fine on Saturday, then had bloody diarrhea late on Saturday evening, tried to drink some water afterward and vomited it right back up, and seemed lethargic when she went to bed. When she awoke on Sunday morning, she observed him having a seizure-type episode, and at the time she called, the dog couldn't really walk, was "breathin' pretty hard," and had blood coming out of his mouth.

My response was, "It sounds like your dog may be very sick and we'd recommend that you bring him in right away." (Note: for anything that may not be emergent, I get the caller's name and number, check with the intern on duty, and give them a call back with advice [which is pretty much always "Bring your pet in"]. This was one case where I felt pretty darn sure what the intern's advice would be!)

The caller's response was, "Well, I got some things ta do this mornin' but I'll try an' bringim in in a coupla hours." I reiterated that it sounded like it shouldn't wait, and she said she'd be in when she had time. (The little dog arrived just as I was walking out at the end of my shift, and fortunately looked to be in decent shape, just based on my cursory glance.)

My challenge yesterday was to figure out how to get from a daytime sleeping schedule to a nighttime sleeping schedule in the course of 24 hours. What I ended up doing was heading to church in the morning, then coming home and napping from about noon till 4 (though I'd set my alarms for 2 pm, but don't remember hearing them or turning them off, which I apparently did). Several hours of wakeful grogginess ensued, then I headed to bed for the night around 9:15 pm -- only to awake at 4:30 am feeling quite well-rested and ready to start my day, so here I am!

I can imagine getting used to a regular schedule of working overnight hours, as long as you didn't have to do much switching back to daytime shifts. By the end of the week, when I had gotten into a routine (you all know I love my routine!), I felt pretty human for most of the day. I'm fortunate that I can sleep easily during the day, so that helped me adjust more quickly at the beginning of the week. However, I have a feeling that today is going to be a long day, and that it'll take me a couple more days to fully switch back to regular hours. Luckily, I may get all of Labor Day weekend off, so I anticipate some serious sleeping in and napping to fill up the Sleep Bank before I head into what may be an exhausting 2-week oncology rotation.

Urgent Care (7 am-6 pmish?) starts today. Hope I like it!