Overnights: 3 down, 4 to go

I'm almost halfway through my week of CCU overnights, and it's been going well.

Sunday night was about the right amount of busy -- not too many patients, which was good because I was still learning how to do everything, and no emergencies came in.

Monday night was slower than Sunday, with only 4 patients for me and 5 for my rotation-mate. Mine were:

1. The middle-aged Shih Tzu from Sunday night, who for some reason ended up scheduled for his surgery on Tuesday instead of Monday so spent another night with us
2. An adult Lab who ate grapes
3. An elderly Lab post-op following a partial mandibulectomy for a recurrent aggressive melanoma
4. An elderly shepherd cross presented with anorexia, vomiting, and lethargy, and just diagnosed with GI lymphoma and slated to start chemo the next day

No emergencies again on Monday night.

Last night (Tuesday night) was a bit more hectic. I started out with 5 patients, then gained a sixth early on in the overnight shift:

1. A young Presa Canario (the dogs that kill people) post-op following a 12-hour-long surgery for Wobbler's (a vertebral malformation in the neck); thanks to ongoing infusions of happy drugs, he neither bit me nor made any attempt to do so
2. An adolescent shepherd cross who ate a bunch of Rimadyl (an NSAID) and a loaf of bread
3. A middle-aged Dachshund post-op following a hemilaminectomy for an acute disc herniation
4. A senior coonhound post-op following a partial mandibulectomy for a squamous cell carcinoma
5. A young Lab post-op following an enterotomy for a rock foreign body
6. A middle-aged cat who was seen by his rDVM 2 days prior for urinary obstruction; the rDVM placed a u-cath but sent him to us last night after being unable to remove the u-cath (he was headed for surgery today to remove his bladder stones, urethral stones, u-cath, and for a perineal urethrostomy to avoid re-blocking in the future)

We had no new emergency patients come in, but patient #4 above (the coonhound with the mandibulectomy) gave us an adrenaline rush. She was housed in ICW (intermediate care ward, a room across the hall from CCU that is usually used for stable post-op patients who just need IV fluids and IV pain meds overnight, then go home the next day -- ICW is staffed by a CCU nurse who is in there pretty much constantly supervising the patients, but does sometimes leave for a couple minutes at a time if everyone is doing well).

The CCU nurse left ICW for less than 60 seconds, and when she came back, the coonhound was covered in blood and there was blood gushing (like, literally gushing) from her mouth. This is a dog who, while not a total nutjob, did get removed from her baby-gated area in the corner of the room after trying to jump the gate, was wearing an e-collar after trying to chew out her IV catheter, and had been banging said e-collar around on the walls and doors of her cage.

The nurse rushed the dog across the hall to CCU where we immediately applied pressure and ice to the bleeding incision. However, the dog kept bleeding, and rapidly transitioned from her previously very alert state to basically passed out on the table in front of us. We bolused IV fluids and checked a blood pressure -- her systolic bp, previously normal, had dropped to between 50 and 60 -- low normal is 90-100. Her heart rate was dropping and her pulses were weak. We put her on an EKG and flow-by oxygen. Another nurse placed a second IV catheter. They called the doctor who had performed her surgery earlier that day, and the doctor rushed right in. Only 5-10 minutes after the dog's bleeding initially started, it was apparent that she had lost a massive amount of blood, so we started a transfusion. As soon as the surgeon arrived, back to surgery she went.

All in all, it was a definite spot of excitement in what was otherwise a pretty routine evening. It was crazy how much and how quickly the dog bled -- if she had been unsupervised for, say, 5 or 10 minutes, she could easily have bled to death. It was lucky that her bleeding was noticed immediately, which is why these patients are kept so closely supervised after surgery. I passed her rolling out of surgery this morning as I was leaving, and she seemed to be doing well (at least she was no longer bleeding, and they had washed her off -- she was a mostly white dog, of course).

Schedule-wise, I feel like I've adapted pretty well to overnight shifts. The first 2 nights and days were a little rough, but last night I really felt awake and almost normal throughout the entire overnight shift. Yesterday I slept for about 3 hours in the morning, then got up and had some lunch (dinner? breakfast? Chinese food, at any rate) and went back to sleep from noon till 5. Today I slept pretty much from 10 am-5 pm with minimal interruptions. It's nice to be able to sleep during the day -- I've heard horror stories from classmates who have had 5 or 6 of their overnight shifts before they can finally get on a sleeping schedule and sleep for more than just a couple hours in any 24 hour period.

Last night during some downtime, I was chatting with the intern and she asked me if I like emergency medicine. I replied that while the idea of seeing truly emergent patients makes me very nervous and a little panicky, I haven't been on CCU rotations long enough to know how well I actually handle it. Sure, it's fine to help care for and monitor the sick and post-op patients that are in CCU all night, but other than the coonhound episode last night, we haven't really had emergencies yet. The hours are not as bad as I expected -- I'm hopeful that I'll be able to keep up this eating and sleeping schedule for the rest of the week -- and it's certainly nice to do shift-style work, where whatever isn't done by the time the next shift arrives at 7 am, I can pass off to them and just leave when rounds are done between 7:30-8 am. The CCU nurses are really great -- they are fantastic at teaching technical procedures like placing IV lines, urinary catheters, blood draws, injections, etc. -- and they stay extraordinarily calm when things go wrong or it gets hectic. I guess I might like CCU/emergency work more than I thought I would, but at this point I can't really picture myself going for employment at an emergency clinic or anything like that after graduation. Maybe that will change; who knows.