Day Off

My day off is almost over. Slept most of it away...was on 4p-4a last night, walked out of the clinic this morning at 8am...long night..started out with a respiratory arrest that needed CPR and unfortunately did not make it. I had 8 patients in ICU...started out with my most critical patient, a dog with Bradycardia (heartrate was 30, normal is 100-120) Yikes!!! Hooked him up to ECG, sinus bradycardia...what causes this? heart electrical problem (sick sinus syndrome), other primary heart disease (valve or myocardial), increased intracranial pressure, systemic illness, vagal influence, electrolyte abnormalities...start the work-up...ok maybe not, too expensive for owner so we will just do an atropine response test to see if the heart responds, if it does then systemic illness and vagal disease is most likely although still could be an electrical abnormality in the heart...so what happened? Administered atropine Iv, heart rate increases to 130-140, dogs walks around feeling great because he is finally getting blood pumped throughout his body...next up, complete work-up to search for systemic/metabolic disease...if that is normal then its off to the old stompin' ground UW-Madison for a cardiology consult and likely pacemaker implantation...owner still deciding when I left. By this time it is 10pm and the doctors on the floor are getting swamped so I am pulled onto the floor to see a nice friendly gray cat who has been straining to urinate...I palpate bladder and sure enough feel distended, rock-hard bladder...yup he's blocked....then it's into the room to discuss FLUTD (feline lower urinary tract disease) with the owners, treatment options...oh and by the way it is $900-1100 for the first 12 hours..he will likely spend at least 2 days with us if not longer...amazingly owners always go for it...(this is because kitties have a special place in your heart!!)...so it is in to procedures to unblock him and then he's off to ICU on fluids and indwelling urinary catheter and pain meds..ok that's 9 I have now. Next up is a 2 pound Min. Pinchser (yes she was adorable),..unfortunately she got under foot and now has a crooked front leg and is mad painful....i do radiographs...diagnosis: simple complete transverse fracture of the radius/ulna, I place a Robert-Jones bandage and splint and send her home (after a pain injection) so that she can go to her vet tomorrow for cast placement...ideally I would have placed an IM pin and external coaptation or a bone plate...too expensive for this owner. It is small dog night because I then see a baby Chihauhau who awas bitten in the elbow by her sister and is now limping...I feel no broken bones and she doesn't seem painful over the bones, however I am worried about the joint space...owner does not want to pay for radiographs though so I clip and clean the wound and send her home with NSAIDS (of course I did an AZOstick first, Duh) and Clavamox (antibiotics) and instruct them to monitor her closely because I tell them I am concerned about joint involvement...they love this little dog and I am confident if she worsens they will bring her back so I feel a little better about no rads. Lastly I see a wildilfe sparrow that someone has found in the street and brought in...I suspect fractured tibiotarsus (its shin bone) and dislocation of the shoulder joint...cant do much becuase it is wildlife so I place in in a warm cage with food and water and IM (intramuscular) pain medications..wildlife officer will pick it up in the morning and it will either get rehabilitated or euthanized...sad but at least I have done my part to stabilize it and make it comfortable in the meantime. It is now 3am and I have got 7 ICU patients to examine yet as well as I am now the primary doctor on the floor since 1am...so I head into ICU at 3am and pray for no more triages... I examine the police dog who is just here for boarding, the dog with the allergic reaction and swollen eye, 2 more urinary blockage cats who I had unblocked the other night, a cat with URI (upper respiratory infection), my puppy from last night with pneumonia, and I check in on my heart dog....oh great his heartrate is back to its old 30bpm and he is laying there like he has no energy to move...well, I have done what I can now we just wait for the owner to decide what he would like to do...so I visit with him even though I have no time and jostle him around a bit so that his heart rate at least increases to 50bpm. I also start Theophylline to try to see if it works to increase the heartrate...there is a paper out there showing it's efficacy so we are trying it to see...It is now 4:01am and they call a triage...thank-you I am off the floor...I let the floor nurse triage it to me though because at the moment the 4a DR is not in the room...It is a dog that ate a whole bag of macadamia nuts overnight...these are toxic to dogs (cause v/d and also hindlimb weakness by a yet unknown mechanism)..dog vomited up a lot of the nuts at home and was very lethargic but is now doing good out in the lobby...i ask nures TPR (temp,pulse,respiration)...dog has tachycardia at 210 so I am a little concerned and about to go take the case when the other 4a dr walks in...thank-god...so I triage to her and the last I heard she is talking on phone to poison control because the dog is weak in hindlimbs...do we make it vomit? I am not sure what happened....I round my cases to the 4am ICU docs and then sit down for 4 hours of paperwork then it is home to my own negleted kitties who sit and watch me shower and then crawal under the covers and sleep away the morning with me. I only got 4 hours of sleep because at noon Kevin called and then AT&T called and so I gave up on sleep and instead got up and went for a run. I then showered and went to get a haircut...yes they cut it too short but I have not enough energy to even worry about that at this time. I am learning to live with no sleep and tiredness. Tomorrow I am back on the floor 2p-2a as well as Wednesday...then I have Thursday off...I have found that I take it one day at a time now...getting through one day to the next...until finally it will be July 8, 2008 and I will be able to walk out of the clinic for the last time!!! Then where do I go? I have got to start thinking of that and looking at clinics....I want a big city somewhere....I like having things to do and I want a large clinic with capabilities to perform diagnostics and treat so that I do not have to refer all my cases out to another clinic...maybe Minneapolis...maybe the west coast...maybe Boston...likely not WI...have to look around to see where clinics are...unless I try for internal med residency...in which case I would want either UofMN, UW, Iowa, or MI state...somewhere in the midwest near family and friends...because 3 years is a long time....i want to be able to see them every once in a while.