My first day of internship I was on-call in the MICU. I got one lady in the morning, who had been resuscitated after a cardiac arrest. Her family agreed to withdraw care, and she died in the late afternoon. I had another lady who was resuscitated after an arrest; it seems like she had some kind of vascular catastrophe somewhere, and she died in the early evening. It turns out there's a lot of paperwork for people who die on you like that, especially when they haven't been in the hospital for 24 hours.
Then in the evening, I got a bolus of three patients: one lady with hyponatremia (110), which turned out to be psychogenic. I did the world's worst H&P on her, and basically ignored her. I got a shambles from a rehab: chronically trached, chronically infected, chronically almost no mental status. Just sorting through all of his issues and entering his orders took forever.
And I got one post-op urology patient (who due to a vagary of the system, is cared for overnight by the MICU team, which is to say, me). She turned out to be really, really sick. The blood samples we got kept coming back hemolyzed, and it took a long time to figure out that it was because she was hemolyzing intravascularly. She went into hyperkalemic arrest at 4am or so, and died after a forty-five minute code. That was a whole bunch of paperwork, too.
I was still working on the sequelae of all of that when the team showed up to round at 7am. I left at around 10am after rounds to go home, and I wanted to quit medicine; I thought I just wouldn't be able to do it. I went home and slept and felt somewhat better. I came in the day after that, and talked to my residents and the ICU attending, and was encouraged by them. That helped a lot, too.
The shambles guy died in the unit a week later. The hyponatremia lady is fine, I guess; I've wondered whether I should warn her that she's the only one of my five admissions who survived the month.
I've never had another night that was anywhere near as difficult, both because that was an unusually hard night and because I'm smarter and more experienced now. I still feel bad about the hyperkalemic arrest. If I was only a couple of weeks smarter, I might have prevented her death that night. I wouldn't have made a lot of difference; her prognosis was terrible. But letting one's patient die in hyperkalemic arrest is just bad form.
I know this: I'm a better doctor for that day. (But I sure wouldn't want to go through it again.😱
). Needless to say, I have not had a single attending run-in since but ironic that it happened within 2 hours of my first shift. 
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Pretty much scared fecal-less at this moment, especially since I haven't made a clinical decision in oh......6 months. I know I'll survive, but I also know that if Chuck Norris decided to kick me in the junk I'd "survive" as well......it'd just hurt like a mother. Oh well, wish me luck everyone. I hope all you new 'terns are as ready as I am.
