Jet's Day At The Hospital 10jan08

[jetproppilot]

Today my assignment was OB, PAIN, and LINES.

So I'm responsible for the OB unit, making pain rounds on the post op PCAs and epidurals, and placing any central lines/A lines requested.

I get to the hospital at 0620.

Night CRNA tells me they called Dr White (on call the night before) for a labor epidural. She's coming, but from home. So I call my partner on her cell and tell her to cancel, I'm here (early), don't worry about the epidural. I've got it.

Walk up to the 4th floor and place my first epidural.

C section at 0700. Put the spinal in (HB bupiv 15mg + 25 mikes fent + 200 mikes duramorph), wait til incision, block is good.

Go back to 3rd floor. Grab pain book which has just been updated by Janet. Janet is employed by our group to do clerical work in the OR and orchestrate the day. She's worth the money we pay her, which isnt much.

27 pain patients to see. I do gravity rounds... starting at the top and moving lower.

Up to the seventh floor.

I get through 10 people when the pager goes off.

Back to OB to start the second C section.

Done.

OB nurse says 2 ladies ready for epidurals.

Put them in.

Back to the 7th floor to finish.

Then through the 6th, 4th floors before a call for another epidural.

Back to OB, put the epidural in.

Walking outta the room, another OB nurse is ready for an epidural.

Put that one in.

To the ICU. 2 pain patients there.

Pager goes off. I keep it on vibrate since I hate that f u kk ing BEEP BEEP BEEP sound. Think I'm gonna figure out how to record my S.O.'s voice on my pager to say "Baby, someone's callin' you....would you mind looking at your pager?" Until then I'll keep it on vibrate during daytime hours.

Central line in ICU 21.

"GOLDEN!" I say to myself, since I'm already here.

Subclavian placed.

Down to 2nd floor to see my last pain patient.

YAY!!!!

I'm done with pain rounds.

SO far I've finished rounding on 27 pain patients, started 2 C sections, placed 5 labor epidurals, and put in a subclavian.

Its 1030. Go to doctors lounge for a cuppa java and to see my honey who has done a lap chole and a cuppla breast biopsies. She's got a cuppla more cases to do. She'll be in her Cayenne headed home at 1330.

Noon C section started.

Another epidural.

Then another C section, bringing total to 4 C sections and I forgot how many epidurals.

At 1330 I take a few rooms over in the OR to let one of my partners go home.

Take over a spinal fusion already in progress. Start a D&C, patella fx.

To the doctors lounge...on the computer to sign all my charts electronically.

Go see 2 pre-ops.

Got some down time for a while.

Then to day surgery to deal with someone whos going home but BP is high and sats are kinda low.

Take care of that.

To PACU. Spinal fusion who was on a ton of opiods pre-op is in alotta pain.

Deal with that.

Its 1445.

OR has moved well today....on call doc is here.....he + late call doc can handle the load so I'm walking out to the monster truck at 1500.

Not a bad day.

Accomplished alot.

And out at three o clock.

Go get my kids.

To my 4 year old's karate class at 1615.

Drive home, play Lego star wars with my 4 year old.

Cook dinner.

Read a pop up airplane book to my 2 gorillas.

Billy the 2 year old pulls about 18 trash bags outta the box and scatters them all over the floor.

And somehow he gets into the dishwashing liquid. All over his nose.

Eat dinner.

Play hide and seek for a while.

Put Nickelodeon on. Josh & Drake is on.

Time for baths!

Gotta go............

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[Noyac]

Sounds fun, all of it. My current gig as you know is not nearly as busy and at times I miss that part of the business. But I am on call tonight and therefore I will be slashing up the bowls on Silterton Mtn tomorrow. We all have our priorities.

 

[johankriek]

Today my assignment was OB, PAIN, and LINES.

So I'm responsible for the OB unit, making pain rounds on the post op PCAs and epidurals, and placing any central lines/A lines requested.

I get to the hospital at 0620.

Night CRNA tells me they called Dr White (on call the night before) for a labor epidural. She's coming, but from home. So I call my partner on her cell and tell her to cancel, I'm here (early), don't worry about the epidural. I've got it.

Walk up to the 4th floor and place my first epidural.

C section at 0700. Put the spinal in (HB bupiv 15mg + 25 mikes fent + 200 mikes duramorph), wait til incision, block is good.

Go back to 3rd floor. Grab pain book which has just been updated by Janet. Janet is employed by our group to do clerical work in the OR and orchestrate the day. She's worth the money we pay her, which isnt much.

27 pain patients to see. I do gravity rounds... starting at the top and moving lower.

Up to the seventh floor.

I get through 10 people when the pager goes off.

Back to OB to start the second C section.

Done.

OB nurse says 2 ladies ready for epidurals.

Put them in.

Back to the 7th floor to finish.

Then through the 6th, 4th floors before a call for another epidural.

Back to OB, put the epidural in.

Walking outta the room, another OB nurse is ready for an epidural.

Put that one in.

To the ICU. 2 pain patients there.

Pager goes off. I keep it on vibrate since I hate that f u kk ing BEEP BEEP BEEP sound. Think I'm gonna figure out how to record my S.O.'s voice on my pager to say "Baby, someone's callin' you....would you mind looking at your pager?" Until then I'll keep it on vibrate during daytime hours.

Central line in ICU 21.

"GOLDEN!" I say to myself, since I'm already here.

Subclavian placed.

Down to 2nd floor to see my last pain patient.

YAY!!!!

I'm done with pain rounds.

SO far I've finished rounding on 27 pain patients, started 2 C sections, placed 5 labor epidurals, and put in a subclavian.

Its 1030. Go to doctors lounge for a cuppa java and to see my honey who has done a lap chole and 3 breast biopsies. She's got a cuppla more cases to do. She'll be in her Cayenne headed home at 1330.

Noon C section started.

Another epidural.

Then another C section, bringing total to 4 C sections and I forgot how many epidurals.

At 1330 I take a few rooms over in the OR to let one of my partners go home.

Take over a spinal fusion already in progress. Start a D&C, patella fx.

To the doctors lounge...on the computer to sign all my charts electronically.

Go see 2 pre-ops.

Got some down time for a while.

Then to day surgery to deal with someone whos going home but BP is high and sats are kinda low.

Take care of that.

To PACU. Spinal fusion who was on a ton of opiods pre-op is in alotta pain.

Deal with that.

Its 1445.

OR has moved well today....on call doc is here.....he + late call doc can handle the load so I'm walking out to the monster truck at 1500.

Not a bad day.

Accomplished alot.

And out at three o clock.

Go get my kids.

To my 4 year old's karate class at 1615.

Drive home, play Lego star wars with my 4 year old.

Cook dinner.

Read a pop up airplane book to my 2 gorillas.

Billy the 2 year old pulls about 18 trash bags outta the box and scatters them all over the floor.

And somehow he gets into the dishwashing liquid. All over his nose.

Eat dinner.

Play hide and seek for a while.

Put Nickelodeon on. Josh & Drake is on.

Time for baths!

Gotta go............

nice

i hope you are getting paid a lot of money

my day today.. Im even embarassed to post it.. it pales in comparison.

it involves my typical day in Los Angeles Larry david style

and im prolly making about the same as you.. as sad as that sounds..

anyway ill post it a little later

gotta go meet someone at the culver city gym i belong too..

 

[toughlife]

Sounds like you are very efficient.

 

[jetproppilot]

nice

i hope you are getting paid a lot of money

my day today.. Im even embarassed to post it.. it pales in comparison.

it involves my typical day in Los Angeles Larry david style

and im prolly making about the same as you.. as sad as that sounds..

anyway ill post it a little later

gotta go meet someone at the culver city gym i belong too..

I should add that the OB, pain, and lines assignment is the most laborious of assignments.

You're all over the place...constant motion.

Other days aren't near as busy.

I'll post my day tomorrow.....which I'm sure won't be as all over the place since I'll be in the OR only.

 

[Noyac]

OK, I'll post my day. Arrive at the hosp around 7am on call today. Partner calls me on my way to the hosp for help with interscalene block at the ambulatory hosp. since his last 2 were not adequate in his words (he is a very strong anesthesiologist and the fact that he asked for help just shows how good he is and is not to big to ask for help). Then off to the main hosp to do the pain rounds, 5 pts. Room 4 is running behind since surgeon was 45 mins late and is now threatening to run into the following case so I take over case so partner can get back on schedule. We float on-call and then are in a room after lunch usually. New locums guy has mtg with administration so I go and take over his case at 9 am. Next, I'm off to ASC to do my requested case of one of the nurses having knee surgery planned for 12 pm but we are running 1 hr ahead of schedule. I send partner home since I can finish his room and OB is quiet. Finish room around 1:30, grab some lunch and call partner that was post-call to check on ski conditions. Mtg with nurses and Infectious Disease Doc regarding abx's their administration is cancelled. Pick up charts to review for PROC committee mtg later. Called for labor epidural around 3 pm then go to PROC til 6:30 pm. I'm home for 7 pm to follow up on some surgical site marking protocols from Joint Commission. Not bad for a call day.

My previous gig was just like you describe Jet except that I frequently (approx'ly 2-3 days a week) would place 6 - 15 lumbar/cervical epidurals, facet blocks, sympathetic blocks then return to the OR to pick up a heart case b/4 going home. Funny how that practice was just about 1 hr down the road from you, huh.

Who knows Jet, maybe if this global warming trend continues and the snow disappears from here I'll jump back into the front lines and come knocking on your door for a job. IF I moved closer to home, N.O. is about the only place I could see myself in.

 

[jetproppilot]

OK, I'll post my day. Arrive at the hosp around 7am on call today. Partner calls me on my way to the hosp for help with interscalene block at the ambulatory hosp. since his last 2 were not adequate in his words (he is a very strong anesthesiologist and the fact that he asked for help just shows how good he is and is not to big to ask for help). Then off to the main hosp to do the pain rounds, 5 pts. Room 4 is running behind since surgeon was 45 mins late and is now threatening to run into the following case so I take over case so partner can get back on schedule. We float on-call and then are in a room after lunch usually. New locums guy has mtg with administration so I go and take over his case at 9 am. Next, I'm off to ASC to do my requested case of one of the nurses having knee surgery planned for 12 pm but we are running 1 hr ahead of schedule. I send partner home since I can finish his room and OB is quiet. Finish room around 1:30, grab some lunch and call partner that was post-call to check on ski conditions. Mtg with nurses and Infectious Disease Doc regarding abx's their administration is cancelled. Pick up charts to review for PROC committee mtg later. Called for labor epidural around 3 pm then go to PROC til 6:30 pm. I'm home for 7 pm to follow up on some surgical site marking protocols from Joint Commission. Not bad for a call day.

My previous gig was just like you describe Jet except that I frequently (approx'ly 2-3 days a week) would place 6 - 15 lumbar/cervical epidurals, facet blocks, sympathetic blocks then return to the OR to pick up a heart case b/4 going home. Funny how that practice was just about 1 hr down the road from you, huh.

Who knows Jet, maybe if this global warming trend continues and the snow disappears from here I'll jump back into the front lines and come knocking on your door for a job. IF I moved closer to home, N.O. is about the only place I could see myself in.

Global warming is a political crock of s h it, Mikey.

So IMHO your professional snowboarder fakey days are not in jeopardy.

 

[Noyac]

Global warming is a political crock of s h it, Mikey.

So IMHO your professional snowboarder fakey days are not in jeopardy.

Yeah, the warmer this globe gets the more snow that falls on my beautiful landscape. If this globe gets any warmer I'll be boarding thru the summer.

PS: I'm not surprised you think global warming is a political crock coming from your part of the country.

 

[VentdependenT]

Its no literary masterpiece, but Michael Crichton's "State Of Fear" took the whole global warming thing and SLAMMED it. Yeah I know its fiction but he has so many sources its ridiculous. Its like a textbook but with guns and cannibals. Wish my medical school texts read that easy.

All in all a rather good suspense/action novel.

Check it on your next vacation.

 

[dhb]

Here it goes: get at the hospital at 7:45 (or's start at 8) i got 2 wisdom teeth pulled out yesterday so i look like a freaking watermelon so i ask the attending managing the or to put me in GI/OB.

Go down to GI suites docs and nurses are very laid back and the new resident is fit, nice . Push the white stuff for 5 snake rides 11:30 done.

Up to OB already 4 epidurals in, hang out go eat. Back to OB for 3 epidurals. Decels in one of the morning labouring pt --> C section. Done 16:00, one more epidural then down to the OR i'm late call and there's still stuff going on.

Relieve CRNA from pyeloplasty vent alarm is ringing for high Fi Sevo (3.3) he tells me : "so the Fi sevo is too high and the Fexp (3.1) is too low then? er... no they're both too high cut the gas see you later somehow pt maintains a good BP. Case finishing after surg bickering about minutia pt spontaneously breathing good TV RR 13. Me to attending: can i pull the $hit deep like the rockstars on sdn? he: no f way wait until he pull it himself leaves.
Other attending come in when case is finished, me can i pull this $hit and roll him to PACU? he: sure; aspiration, pull tube jaw thrust end tidal +: i'm golden. (if not for SDN i'd still be in there blowing off the gas )

Next case: kidney stone removal: 7.5 mg heavy bupi barbotage midaz, case done in 15min patient moving legs roll back to PACU.

Next appy/abces by laparotomy patient waited 10 days at home before coming RSI tube in 20:15 see you later i'm out.

 

[johankriek]

Other attending come in when case is finished, me can i pull this $hit and roll him to PACU? he: sure; aspiration, pull tube jaw thrust end tidal +: i'm golden. (if not for SDN i'd still be in there blowing off the gas )
.

I pull mine deep but the patient sure as **** wakes up in the OR. I dont pull my lmas deep to save time.. I pull em deep to avoid complications when pt starts bucking with a huge lma in his/her mouth.

Your asking for trouble if you are wheeling an asleep patient down the hall.. or even worse a patient waking up in the hallway.. can you imagine trying to manage laryngospasm or breath holding in the hallway?

sorry for hi jacking your thread.. carry on.

 

[MErc44]

Its no literary masterpiece, but Michael Crichton's "State Of Fear" took the whole global warming thing and SLAMMED it. Yeah I know its fiction but he has so many sources its ridiculous. Its like a textbook but with guns and cannibals. Wish my medical school texts read that easy.

All in all a rather good suspense/action novel.

Check it on your next vacation.

That was an awesome book, I read it in a day couldn't put it down.

 

[Pooh & Annie]

I pull mine deep but the patient sure as **** wakes up in the OR. I dont pull my lmas deep to save time.. I pull em deep to avoid complications when pt starts bucking with a huge lma in his/her mouth.

Your asking for trouble if you are wheeling an asleep patient down the hall.. or even worse a patient waking up in the hallway.. can you imagine trying to manage laryngospasm or breath holding in the hallway?

sorry for hi jacking your thread.. carry on.

I haven't done peds yet, but aren't the PACU nurses in a peds center well trained in caring for deep-extubation patients?

 

[joshmir]

i may have read your post incorrectly-

do you manage all PCAs on the floor at your hospital? or only pts with PCAs and epidurals? or maybe only PCAs when the "pain service" is consulted?

 

[powermd]

Global warming is a political crock of s h it, Mikey.

So IMHO your professional snowboarder fakey days are not in jeopardy.

Meanwhile in NYC, four seasons have become two. I remember growing up in the CT suburbs we would get lots of snow in the winter, and you actually needed to go out in a coat, hat, gloves, and even a scarf. Not anymore. Temps in the teens used to be common, now it's rare to have a day or night below freezing.

Fall didn't come until mid-November this year.

Jet, it must be nice living with your head stuck in the clouds, literally!

 

[fakin' the funk]

Its no literary masterpiece, but Michael Crichton's "State Of Fear" took the whole global warming thing and SLAMMED it. Yeah I know its fiction but he has so many sources its ridiculous. Its like a textbook but with guns and cannibals. Wish my medical school texts read that easy.

Getting your science from popular fiction eh?

 

[militarymd]

Here's one of my more brutal call days.

Supervising 3 rooms only, but they are packed with cases, and I had a Medical Staff Meeting that I had to attend at noon.

I had 2 ent rooms and one ortho room.

1 ent room had a radical neck dissection on a fat dude.

The other ent room started with pedi bmt and t&as...ages 2 to 4, then moved on to old dudes for sinus and vc surgeries.

One of the VC surgeries was a vocal cord injection under local anesthesia where I will topicalize the airway enough for the ent dude to do an awake DL to visualize cords and inject while awake.

All this going on while the ortho dude is running through his shoulders and totals...all getting some kind of block..

Around noon we had a Ludwigs angina add on that required an awake tube in another room 10 minutes before I had to run off to the staff meeting.

Rush and tube the guys whose head looked like a mellow...before just running off the the meeting....when I get paged for vascular access help on some old gome who was hypovolumic and had a cold dead foot.

Tried subclavian...good blood flow but wire won't pass.....IJ...no blood...call CCM guy and told him no joy...he said ...ok.

rush back to medical staff meeting...

Back to or...things starting to slow down....around 3 pm...start sending people home...and wrapping cases...

But then I get a STAT C-section at 1800 right after I sent the LAST person home...everyone else working....so I start the C-section myself while calling someone in.

One of the cases I was surpervising finishes just as the called in CRNA gets to the hospital....so I send him back home.

Basically wrapped up the day at around 2030 with an ultrasound guided femoral nerve block because both myself and one of my partners could not find the femoral nerve in the normal fashion even though the guy's BMI was 23 and body fat was probably 5 %.

Turned out his femoral nerve was almost underneath his femoral artery.

Went to bed at 2100 for the rest of the night.

 

[VentdependenT]

Getting your science from popular fiction eh?

Thats the safest way!

Yeah I know its total fiction. But whats freaky is the guy starts quoting tons of acutal studies. If I were just a lil' more country it would have completely had me.

 

[jetproppilot]

i may have read your post incorrectly-

do you manage all PCAs on the floor at your hospital? or only pts with PCAs and epidurals? or maybe only PCAs when the "pain service" is consulted?

We manage the PCAs we are requested to write for, and of course manage the epidurals.

We write the orders for probably 90% of the PCAs in the hospital.

Sucks but thats how it is.

 

[VentdependenT]

Painfull Rush Call:

Cases until 9pm

Liver #1 starts at 3 pm.

Liver #2 starts at 1 am.


Thanks guys!

 

[jetproppilot]

Painfull Rush Call:

Cases until 9pm

Liver #1 starts at 3 pm.

Liver #2 starts at 1 am.


Thanks guys!

just seeing the word liver in your post gave me the heebie jeebies Venty......time to go do a healthy c section....

 

[joshmir]

Do you bill for PCA management?

If so, roughly how much for 1 days management?

If not, why does your group manage them?



Thanks so much for your insight, my friend.


btw Jet, I really rec Rock Band for your new X-box....you're lady will enjoy the singing parts, the gee-tar is fun, and the drums.....cognitivelyh/skillwise are basically like real drums. get your gorillas on it and they'll crush a set in a few years.

 

[jetproppilot]

Do you bill for PCA management?

If so, roughly how much for 1 days management?

If not, why does your group manage them?



Thanks so much for your insight, my friend.


btw Jet, I really rec Rock Band for your new X-box....you're lady will enjoy the singing parts, the gee-tar is fun, and the drums.....cognitivelyh/skillwise are basically like real drums. get your gorillas on it and they'll crush a set in a few years.

I'm a paid employee of an Anesthesia Management Service, friend.

Never thought that would happen, but it has, because of circumstances I've explained.

Turns out I'm happy.

Anyway, our group is augmented by the hospital in a big way (cuppla mil) for our services.

Rounding on PCAs doesnt pay much.

But it doesnt matter in this model.

Gotta add, though, in my previous, eight-year bum-f u k-egypt private practice gig where paycheck was about 50% larger than my current salary, we still rounded on PCAs, because the surgeons liked it.

And we liked the surgeons.

They were happy since they didnt have to deal with post op pain issues.

And we were happy since we couldnt spend what we were making.

 

[VentdependenT]

just seeing the word liver in your post gave me the heebie jeebies Venty......time to go do a healthy c section....

I'm ready but its only gonna get worse before it gets better. Next year will forge me into a true son-of-a-b!tch.

 

[urge]

Bump,

So far this week (Monday-Wednesday) I have worked 35 hrs. Tomorrow seems like an 8 hr day. Friday seems like an 11 hr day. ~ 53 hrs a week, WTF!
Beeper call MWF, no post call day off. I'm not feeling the love. Big big cases for little money or time off.

 

[Planktonmd]

Bump,

So far this week (Monday-Wednesday) I have worked 35 hrs. Tomorrow seems like an 8 hr day. Friday seems like an 11 hr day. ~ 53 hrs a week, WTF!
Beeper call MWF, no post call day off. I'm not feeling the love. Big big cases for little money or time off.

You sound like you are close to make the transition to private practice.