I will simply say this...
I've pulled call before, in the unit, where I stood by the bedside of a patient all night long. It started at around 2:30 PM in the afternoon when we got the admission. It was a post-arrest patient. Well, around 6:30 PM, the guy started to crump, de-satting, hypotensive. I got a stat x-ray, and he had a hemothorax. I - yes, me - put a chest tube in him because no one else from surgery was around to do it. Promptly got 600ml of blood out of his chest wall. That was only the beginning of the night... CT surg actually came back in around 9:30 PM and put an aortic balloon pump in the guy.
I was in and out of that guys room all night long, while trying to do other things on the unit and tend to other patients. Around, 1:30 AM, we ended-up coding him again because it looked like the balloon pump had clotted off (or... who the hell knows what happpened... I was literally by myself with a bunch of awesome ICU nurses trying to figure this guy out...). Got a rhythm back, and the balloon pump seemed to be working again. Around 4:30 AM, I'm called back in (away from another not-quite-as-sick patient) because now the guy is de-satting again. Another x-ray. Despite chest tube looking like it's in the right place, his lungs are looking whited out... I had given him blood... now I'm thinking TRALI.
Long story short... I was there to 11:30 AM. I got the guy through it, tended to my other patients, and signed-out to the the day team after rounding. I had lined this guy, put a goddam chest tube in him (something I'd only done once before as a surgical intern), and coded him twice throughout the night. He stayed on our service for the next two weeks with all kinds of bad crap happening to him. There were several times, not just that night, that I talked with his son and daughter and told him that I've done all I could and I didn't think he was going to make it.
Guess what happened? (I **** you not).
Fast-forward a month-and-a-half later. The nurse from the unit calls me and says, "Mr. XXXXXXX is here to see you! You have to come over."
I walk over there, see the guy. He's walked himself into the hospital. He's with his fiance. He sees me, instantly remembers me, and tells me - "thank you, doctor, for saving my life" with tears in his eyes.
I can honestly tell you that, in that almost 30 hours straight that I worked, I learned more about practical cardiology, physiology, and resuscitation than I had before or have since. I pushed myself beyond my ability and farther into what I thought I could know or do. And, most importantly, I learned where my limits were - where the outside of that envelope is - and how to effectively navigate into and out of that area.
I've taken plenty of brutal calls. You get to some blurry areas at 4:00 AM after you've done your tenth case, no doubt. But, what are we going to do, as providers, when some crises hits our locale? What happens if there is a plane crash or explosion - some kind of mass casualty - and you are forced to push yourself to the limit... especially if you haven't been there before?
I'd much rather learn where my limits are in residency under the protection and indemnification of the training program than on my own. So, I gotta agree with Mil on this one. This is just more pussification of our profession, and it is creating less distinction between what we can and are willing to provide to the patient versus all the other clock-punchers.
-copro
...finally....a legitimate excuse to lengthen the anesthesia residency to 8 years.....thereby creating a man power shortage....so I can make more bucks in the mean time.
