Hard Day's Night

I just finished a string of overnight shifts. Fortunately, last night was slow and I was able to catch up on all of my dictations. For two blissful hours in the middle of the shift, I actually didn't have a single patient. I saw a nursemaid's elbow early in the shift. Nursemaid's elbow is subluxation of the radial head. It occurs in small tots when they get picked up by the arms or sometimes from sudden pulling forces. It is one of my most favorite things to fix because it is so dramatic. Usually, the toddler comes in with one arm hanging limply by their side, and they refuse to lift it. All it takes is some slight pressure in the right spot and a quick twist, and you get a satisfying click. When you check up on the kid a few minutes later, they suddenly have full function of that arm again. I guess I just like quick and easy solutions.

I was glad to have a catch-up shift after the frenzied pace of the previous nights. In our hospital, there's typically an attending on the pediatric side until about 2 am, and after that it goes down to one attending covering both the adult and the pediatric sides until 8 am. As as 2nd year resident, I now work overnights by myself on the peds side, or with one intern and usually no senior resident on the adult side. The decreased coverage at night is usually adequate, but we can get overwhelmed in a hurry. Discharges can get slowed down as each patient has to be seen by the attending before they can go, and they are often busy with more critical patients on the adult side.

For some reason there is this phenomenon on overnights where parents will awaken their children from a dead sleep and drag them in for the silliest of things (runny nose, rash, etc.) thinking that there will be no wait to get Tiny Tim evaluated at 3 am. This stuff is all pretty benign, but it clogs up the works, and when we actually are busy in the middle of night, people get pissy pretty fast at having to wait.

Things that stalled me up on seeing the rashes in a timely fashion on some of the overnights included: a teenager shot in the neck (the bullet went right through the spinal cord and he's now paraplegic), four teens involved in a rollover (none of them wore their seatbelts), and 5 stab wounds that presented on the adult side all at once. The stabbings didn't involve me directly, but they resulted in a riot in the lobby. It was bad. At one point, parents were asking me if they were safe, and I had to tell them to just stay in their rooms with the doors closed. Apparently, there was a metal detector malfunction.

Last year, we had a metal detector that didn't actually work. Then they put up a "No Guns" sign. Finally, we got a working metal detector. When the thing goes off, the entrance door to the waiting room automatically locks. Apparently, the lock malfunctioned, so there was suddenly a horde of people in the waiting room, and people fighting in the street. We have our own security guards, and PD was there quickly, but we basically had to go on internal disaster and completely shut down until the lobby could be cleared out. All of my sore throat and fever kiddos had to be police escorted with their parents to the parking lot.

It didn't help matters either that I'm still getting over my stupid respiratory virus. I was feeling much better, but then started to lose my voice. It was so bad that by the end of one of my shifts, the parents were having trouble understanding me. My voice kept cracking like a 13 year-old boy's. I can only imagine all of the blanks that will be showing up on my dictations.