My Toxic First IM Duty

Yesterday mark my first tour of duty in the department of internal medicine and its one would say "a toxic duty". Toxic in terms of admissions (we had I think around 15 admissions) and most of the admissions are not so stable patients. So after logging in the intern's logbook, I then met my IM residents and told them that I would be their intern for the next two months.

My night started with two NGT insertion, one patient had an esophageal cancer which made it really difficult to insert an NGT tube, while the other patient was 92 years old whose gag reflex was already poor causing the tube to go to his lung area. After this two encounters, we were faced with two patients whose O2 saturation was going done. One was an in-patient while the other one was a new admission. Both of them where supposed to be for intubation but good for us both of their O2 saturation rose again above the 90's. Even though bought of them become comfortable in terms of their breathing, still both of them were for closed monitoring. I then had my dinner at a nearby fast food. Admissions still poured in and we (me and my resident) continued are ward rounds.

The term "save the best for last" was applicable for me this early morning around 4 am. I got a call from one of the ward nurses informing me that one patient was for monitoring. So I get up went directly to the patient's room and monitored her every 1 hour. She was a 38 year old patient, pregnant by 30 weeks and 5 days AOG who complained of chest heaviness. ECG was immediately requested which yielded a suspicious reading, cardiac enzymes was then next on the list. So while waiting for the results, I monitored the patient every one hour. Around 6 to 7 in the morning I got the results from the laboratory, which shocked me, her cardiac enzymes were positive, causing her to have a MI (myocardial infarction).I then relayed the results to my resident which made her jaw dropped. The OB department was then immediately informed.

I only spent 1 lowly sleeping hour in last nights tour of duty, hopefully my next tour of duty won't be as hectic nor toxic as this one. Pleasant Day