医学生日记2016年4月15日---值夜班

阿山 （庞静译）

普外的手术见习要求我们值三个夜班。对于我们，重点是学习，没人指望我们是夜班团队中很能干的成员。所以，有时侯，上夜班的住院医对周围的见习生不太热心。见习教导主任鼓励我们要积极争取这方面的见习经验，比如一直跟着值夜班的住院医，他走到哪里，你就跟到哪里，别在值班室睡觉。我的朋友，已经值过夜班了，他说值夜班时通常不能睡觉。如果发生什么事，我们应该看的，住院医就得用呼机叫我们。所以多数人在值班室看不到床，而是呼机。

早5:45 - 下午6:00

像通常一样，我开始了这一天的工作，先加入儿科手术早晨的病房巡查。今天不太忙，整天都是门诊。总之，工作天一般都这样。虽然我们一直在工作，但是并不觉得忙碌或赶着什么。

下午6:00 - 晚8:00

我结束了一天的儿科手术工作，拿到了夜班呼机。呼机都放在值班室，值班室在医院地下室的角落，那里根本没有联线电话。唯一可以跟这儿联系上的就是医院的呼机。

我换上灰色手术大褂，按规定，我们不能在医院以外穿这大褂。所以我只能在医院食堂吃晚饭。医院食堂晚饭可选项很少，我吃了炸鸡肉，喝了一瓶可乐。今天已经工作了十二个小时，这是我首次往我身体里添加咖啡因和糖，我为马上就开始的夜班感到兴奋，憋足了劲儿。

我呼叫了值班住院医，告诉他今晚轮到我值夜班。我等了一个小时，没反应。这时候，我心里面没谱，是否就该这样，还是有些事正在进行，我是否应该加入呢？咖啡因和糖开始在我身体内生效，不是警觉和有劲儿，反而是特别着急。我给我的朋友们发短信，他们已经值过夜班了，我问他们怎么开始的。他们都告诉我安心等待，一定会有人叫我，但是他们都没法告诉我什么时候才有人叫我。我坐在住院区的电脑前，旁边一个同学还在认真地工作。我问他星期五晚上了还在这儿干嘛，他说一星期六天，从早四点到晚八点就是他的正常工作时间。我心里有一点绝望。他在结肠科，下一个半星期我就得在那个科了。

大概晚上七点的时候，我的呼机还是没有任何动静，我又呼了一次。这回，住院医给我回话了。他告诉我不用呼他，也不用跟着他。如果他觉得有些事情我应该看的话，他会给我送短信。在电话上，他显得不耐烦，似乎在告诉我这一夜他最不乐意的事情就是有一个见习生跟屁虫。所以，我就去了儿科手术工作室，那里，我的手机有信号，还能接电脑和呼机。

晚8:00 - 凌晨1:30

这段时间我一直坐在电脑前看网上节目。我接到一个急诊部门的咨询呼叫。我直接去那里取得一个女患者的资料。他们想确定现在她是否需要手术。由于能够介入的兴备，我没想到应该先仔细看看患者的病历。我直接去那儿取得患者的病情和她的病史，做了一些检查。住院医到的时候，我觉得已经掌握了病人的情况。当我直接检查病人时，住院医却先看了她的病历。所以住院医来的时候他根本不需要听我或病人说什么。他直接告诉急诊医生病人不需要当夜手术。这时大约夜里11点，我觉得自己的兴奋和努力都白搭了。当我花时间花精力了解病人的情况，力图解决问题时，人家只在电脑前花了五分钟就足够得到同样的结论了。

这件事完了，住院医让我回去随便做什么，他自己也回去做他的事。我溜回我的工作室。这件事令我的精力沉到了谷底，我下楼又去喝可乐吃烤饼。

随后几个小时我看了更多的网络节目，硬撑着睁开眼皮，强迫自己不停地看看呼机，特别担心什么事情发生了，我却错过了。

最后，大约1:30的时候，我开始觉得特别累，发冷。我朋友告诉我这种反应就是身体体力到达极限的信号。我决定洗把脸，我熬不过这一夜了。我收起我的东西，走去学生休息室。那里有个沙发，我能躺着睡觉，还不会错过手机，网络，或呼机信号。

凌晨1:30 - 早晨5:30

我刚到那里，我的呼机就开始叫。心肺呼吸科团队紧急进入手术室。主治医生和专科医生都被叫来了。这些人级别高，不用整夜呆在医院。他们被从家里叫来监督手术。这已经很不正常了，普外手术也得负责夜里急诊的需要。当时状况是一个女患者腹腔或食道出血，可能进入了肺部和胸腔。通常这样的出血只在腹部，但由于先前的手术，女患者的生理结构已经不一样了。主要怀疑血流入胸腔，如果压迫到心脏或气管就很危险了。所以心肺呼吸科团队被叫来了。如果血不能马上止住，患者随时会死。

我帮忙做了一点手术室的准备工作。我套着无菌大褂，手套和面罩进入了整个过程。在处理过程中，主治医生和专科医生都致力于快点解决患者的问题，要不是为了保住患者的生命，他们谁也不情愿半夜来医院。专科医生确实也花了点时间教我一点有关这个病情的事情。但是我大部分时间都得撑开切口，让他们有操作空间。

这个处理过程用了三个小时，我感觉累极了。我必须强迫自己醒着。我的头不断有一种被冲了的感觉，就好象身体的血液都流到下面了，经过肚子，到了脚上。那是一种头轻了、又重了、伴随着颤抖想呕吐的奇怪感觉。我不明白我怎么可能一直稳稳地站着，手一直稳稳地撑着，可是整个处理过程我都是这么做的。

切口缝上之后，我为患者清洗，然后清理手术室，帮助把病人送到特护室。走一走，比起站在手术台旁边，我觉得血液循环好多了。但是，仍然觉得消耗光了。屋里的人都在打哈欠，你可以很清楚地看到手术医生们眼睛下面的黑圈。

早晨5:30 - 6:00

我从特护室一出来，就得到另一个呼叫。急诊室有一个B度撞伤。B度指撞伤二级，病人伤得很重，可能伤到了脑袋。A度指问题严重到，如果不立即采取措施，将危及病人生命。所以我赶快去了急诊室，等待急救车到达。我知道我不会参与治疗了，但是我想看看医疗团队怎么处理撞伤病人。

病人到了。显然她吃了很多药，试图自杀。她从高速公路下来时把车开到了100 mph, (相当于每小时160公里），车翻了好几个滚。急救车到达时，花了半个小时才把她从车里弄出来。当时，她一直都清醒着，愤怒地尖叫着，一心要死。

她进了急诊室，打了麻药，插了管子。撞伤团队稳妥有效地对撞伤病人采取急救措施。我以前从来没见过这么多人在这个紧急状况下平静地合作有序。他们很快地稳定了病人的状态。我也该下班了。

早晨6:00 以后

我累得晕乎乎的，拖着我自己到了停车场，我站在那里。太阳从山间升起的景象拘获了我。一天以前，也是太阳升起来的时候我到了医院。从那会到现在，我都没有出来外面，也没有再见到太阳。我现在只想用一分钟享受阳光。然后我开车回家，洗个澡，直接睡觉。

我睡了大概三个小时，我身体内的生物钟把我叫醒了。星期六一天我都可以放松，做事，按正常时间作息。但是星期天我觉得起不来床了。体力透支终于把我击垮了，很惨。结果，星期天我连续睡了十六个小时。当我觉得体力基本恢复了的时候，已经星期一了，我又要开始工作了。

Friday April 15, 2016 – Overnight Call

For our general surgery rotation, we are required to take 3 nights of overnight call. It is intended to be predominantly a learning experience for us, there is little expectation for us to be high-functioning members of the overnight team. Hence, sometimes the overnight resident is less than enthused about having a medical student around. The rotation director encouraged us to be very active in our pursuit of this educational experience, such as staying with our overnight resident and following them around the hospital instead of going to the call room to sleep. My friends who had done it previously agreed that generally we should not expect to sleep on these shifts. The residents are instructed to page us when there is something we should see, but that does not always happen. Hence, most people never see the call-room with the bed other than to pick up and drop off the overnight pager.

5:45am – 6:00pm

I started my day as usual, reporting for Pediatric Surgery morning rounds. This day whole day wasn’t too busy, but we had a full day of clinic visits. All in all, this work day was pretty average. We were constantly occupied with tasks, but it never felt hectic or rushed.

6:00pm – 8:00pm

I got off my Pediatric Surgery work shift and picked up the overnight pager. The pager is kept in the on-call room, which is located in the corner of the hospital basement. By design, there is almost no internet connection in the room, and absolutely no cell phone connection. The only signal penetrating those walls were that for the hospital pager.

I changed into my gray surgical scrubs, which as a rule, we are not allowed to wear outside the hospital. This essentially limited me to having dinner in the cafeteria. The hospital cafeteria is extremely limited in its dinner selection, and I ended up just eating fried chicken tenders and drinking a bottle of coke. After a full 12-hour work day, this was just my first dose of caffeine. Having some junk food, caffeine, and sugar in my system, I felt excited and energetic to get started for my overnight shift.

I paged the resident on-call, telling him I was officially on for the night. I wait for an hour and there is no response. At this point, I don’t know if this is typical or if there is even anything going on I’m supposed to be participating in. The caffeine and sugar is backfiring and making me overly anxious instead of alert and energetic. I’m texting my friends who had already gone through this, asking about how they started the night. All of them told me to just calm down and wait, I will eventually be contacted, but none of them were able to pinpoint any time that I should expect. I sat down on the inpatient unit computer next to a classmate, who was still hard at work. I asked him what he was still doing here on Friday night, and he told me his regular hours were from 4am to 8pm, 6 days a week. My insides fluttered a little in despair. He was on the Colorectal Surgery Service, which I will be starting in a week and a half.

It’s 7pm and I still haven’t heard anything from my pager, so I send another message. This time, the resident calls me back. He tells me that I don’t need to contact him or follow him around. He’ll just send me a message if he feels there’s something I should see. Over the phone, he sounded disinterested and tired, and sense told me the last thing he would want is a medical student following him around all night. So I moved up to the Pediatric Surgery workroom, where I could still have cell phone signal, computer access, and wait for pages.

8:00pm – 1:30am

Most of this time, I was sitting in front of a computer watching Netflix. I was paged for one Emergency Department consult. I was to go down to the ED to get a patient history from a woman. They were deciding if she should go to surgery or not. In my excitement to participate, I didn’t think to look to closely at her medical records. I showed up and took a detailed history about her problem, got information on her background, and did some physical examination. By the time the resident showed up, I felt like I had already gotten a good understanding of the patient’s problem. In the time I was talking to her, the resident had reviewed her medical records instead. So by the time he showed up, he didn’t even need to hear any information from me or the patient. He just placed some orders with the emergency department doctors and said the patient didn’t need emergency surgery overnight. So this is around11pm and I’m feeling like my excitement and effort was pretty useless. I had expended time and energy using my patient interview and problem solving skills when a quick 5 minutes in front of the computer was enough to reach the same conclusion.

After this encounter, the resident told me I could go back to whatever I was doing and he was going back to doing things by himself. I slinked back up to my workroom. This experience sent my energy levels crashing, so I went back downstairs to get more Coke and a bagel.

I spent the next few hours watching more Netflix, trying to keep my eyelids open, compulsively flickering them over towards my pager, extremely fearful that maybe something was happening and I was missing it.

Finally, around 1:30, I was starting to feel extremely tired and cold. My friends all described the feeling of cold as a signal that they were hitting their physical and energy limits. I decided I was throwing in the towel, I wasn’t capable of staying up all night. I grabbed my things and headed towards the student lounge, where there was a couch I could sleep on without missing cell phone, internet, or pager signal.

1:30am – 5:30am

Of course as soon as I get to the lounge, my pager starts beeping. The Thoracic CardioVascular (TCV) team is emergently going to the operating room. The attending and fellow had been called in. These were high enough ranked people where they did not stay in the hospital overnight. They were called in from their homes to come oversee this surgery. This was already unusual enough, general surgery is all that is required to handle the overnight emergencies. The fact that TCV was called meant this was an unusual case. The suspicion was that this woman was bleeding from her stomach or esophagus into her lungs and other chest structures. Normally, the bleeding would be into the abdominal space, but this woman had some unusual anatomy due to previous surgeries, so the chief suspicion was that the bleeding was going into her chest, there was significant risk that the blood would compress her heart or airway, hence TCV was called. Also, if the bleeding wasn’t stopped, this patient was going to die pretty quickly.

I helped a little to prep the operating room. I scrubbed (full sterile gown, glove, and mask) into the procedure. During this procedure, the attending and fellow were very focused on quickly fixing the patient’s problem, for the sake of saving the patient’s life and the fact that they did not want to be in the hospital in the middle of the night either. The fellow did try to take a little time to teach me a bit about what was going on, but most of the time I was pulling back and holding open the incision site so they could work in the body space.

This turned into a three hour procedure, and I could feel my body crashing. I felt like I was constantly fighting to stay awake. I kept getting this rushing feeling that would start in my head, and it felt like all the blood in my body was falling down, through my stomach, to my feet. It was a weird mixture of nausea, light-headedness, being extremely heavy, and feeling shaky. I do not understand how I was able to stay standing and hold my hands steady during the entire procedure, but somehow I did.

After the incision was sewn up, I was able to do a lot in terms of cleaning up the patient, cleaning up the operating room, and helping transport the patient up to the ICU. Getting moving and having my blood circulating felt better than just standing next to the operating table, but the exhaustion was still inescapable. Everybody in the room was yawning, and you could see the dark circles under the surgeons’ eyes.

5:30am – 6:00am

As soon as I walk out of the ICU, I get another page. We are getting a B-level Trauma in the Emergency department. The B-level means the trauma is second level, where the patient is critically injured and there is suspected head trauma. A-level means there is significant problems to the patient’s vital signs and death could be imminent without significant intervention. So I power walk down to the ED, waiting for the ambulance to arrive. This I know I wouldn’t be participating in, but I would get the chance to see how the medical team cared for trauma patients.

The patient arrived. Apparently, she had taken a lot of illegal drugs and was trying to commit suicide. She drove her car at 100 mph (160 kilometers per hour) off the highway, and flipped it several times. Emergency services arrived and needed over half an hour to remove her from the car. During this time, she actually maintained consciousness and was screaming about how angry she was and she just wanted to die.

By the time she arrived at the ED, she was intubated and sedated. The trauma team very smoothly and efficiently began the trauma patient care protocol. I have never seen so many people function so calmly as a team in an emergency situation. They were quickly able to stabilize the patient. After they stabilized the patient, it was about time for my shift to end.

After 6:00am

I felt dizzyingly tired. I dragged myself into the parking lot, but I had to stop. The view of the sunrise over the mountains captivated me. I had arrived at the hospital before sunrise the day before, and I had not been outside or seen the sun since then. I took a minute just to enjoy the light. And then I drove home, showered, and went straight to sleep.

I was able to sleep for about 3 hours, until my internal clock dictated that I should be awake. I was able to relax and function throughout Saturday and went to bed at a normal hour. However, Sunday, I felt like I couldn’t get out of bed. The exhaustion finally hit me, and hit me hard. I ended up sleeping about 16 hours on Sunday. And just as I was feeling more recovered, it was Monday and it was time to go to work again.

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