Hey guys. I'm Siobhan, a 3rd year medical resident. I just got to the hospital and I'm starting a night shift and guess who's with me? My husband Mark! Hey guys. So I'm on call for internal medicine. Mark is
on call for obstetrics, so he's delivering babies all night. And this is actually our first time on call together in the hospital. So it will be interesting to see how it goes, maybe we'll have a little bit of time in there to have dinner or just hang out. Oh, that would be so nice. Okay, this is gonna be great. So tonight is the very last call shift that I'm ever doing during my internal medicine residency, so this feels like a momentous occasion. It's kind of hard for me to wrap my head around actually. When you're watching this video, by the time it's published I'll already be starting my residency to specialize in rheumatology. Uh, so this is crazy. Anyway, tonight I'm covering the internal medicine service. So, um... I'm actually covering the COVID floor, as well as seeing any new patients that are coming in that need to be seen by internal medicine. As the resident on call for obstetrics and gynecology I'll be assisting with childbirth. Usually this is natural, sometimes operative, sometimes we need to go to the OR for a C-section. I'm also going to be seeing any gynaecology consults down in the emergency department. Alright, almost 5 o'clock, time to get going. Just gotta do my hair, gotta get it up. I'm ready. Oh, no, I need my mask. You need a mask. Yeah, okay. Share the camera, haha. Okay, so should we try to meet up for dinner? Yeah. Okay, sounds good. I'll text you later. Alright, bye for now. *Pager goes off* Oh hi, this is Siobhan from internal medicine returning a page. Sounds good. Absolutely. Yeah, I'll be right down to see you. Alright, thanks. Bye. Okay, so we've been asked to go and see 2 patients in the emergency department. The first is a patient with sickle cell disease who is coming in with a pain crisis. And the second is an elderly patient who is recently confused, has a fever and was swapped for coronavirus. You may think it looks like the emergency department is under construction, but these are actually temporary negative pressure rooms that were created for the coronavirus pandemic. When I walk in the room, I see a young woman who is clearly in pain. She was born with sickle cell disease, an inherited condition that affects her red blood cells. Healthy red blood cells are round, but in sickle cell disease they can change shape and get stuck in small blood vessels. Cutting off blood supply like this is extremely painful, so we're going to start by checking her blood counts to see if she needs a blood transfusion, give her lots of fluids and pain medications. Guys, look what I found. When was the last time you saw one of these things? Haha. Only in hospitals, seriously. So I have just been called about one of the patients I admitted earlier tonight. It sounds like her water broke and there was some meconium in it. And the nurse was wondering maybe there's some decelerations on the fetal heart rate monitor. So I'm just gonna go take a look at the strip and I'll let you know what I see and what the plan is. Cardiotocography or the strip describes the real-time monitoring of fetal heart rate and maternal contractions during labor. There's so much useful information that we can gather in this way. Importantly, it can warn us of fetal distress that would require an emergency delivery using vacuum forceps or even C-section. Alright, so I just finished reviewing with my staff. We took a look at the strip. It didn't look really concerning to us, because it looks all good, the baby is happy. We're okay with a little bit of meconium for now, but we'll keep a really close eye on the strip and we're going to be calling the NICU staff to be there at the delivery just in case the baby shows signs of meconium aspiration syndrome. When meconium, the baby's first bowel movement, mixes with amniotic fluid, it can form a viscous mixture that prevents a newborn's lungs from inflating properly. Finally in the call room. Feels good. Okay, so as I was walking up here my pager went off. So let's see what that is. Hi, this is Siobhan from internal medicine returning a page. Oh ehm... Okay, yeah sounds good. No, I'll be right down. Okay. Okay, bye. It's a patient who is requiring about 100% oxygen right now, so I'm gonna head down and see this patient right away. Just walking into the room it's clear the patient is struggling to breathe. He's on 100% oxygen and when I listen to his chest, the left side has decreased breath sounds. I work with his bedside nurse and order a STAT portable chest x-ray, ecg of the heart and STAT blood work. Okay, so when a patient's oxygen requirements increase so rapidly, it can be a number of things. You can have flash pulmonary edema from the heart, it could be a rapidly progressing pneumonia, it could be a collapsed lung. In this case I think that it's an aspiration event. This patient has had a stroke in the past, so his swallowing isn't as good. And even the secretions from your mouth, if you're aspirating them and certainly if you try to drink thin fluids, it can go down the wrong way. He can't clear those secretions and you can get a severe aspiration. He is requiring the maximum amount of oxygen that we can give and the next step would be intubating. So putting a tube down his throat, hooking him up to life support. Now he has made it clear that he doesn't want that. So at this point I'm just... I'm really hoping that we can support him and get him through the night with antibiotics and support in terms of oxygen. But I'm gonna give his wife a call, because i'm really worried about him and even during coronavirus times if someone is doing so poorly we'll actually allow a visitor in. So I'm gonna give her a call now. 'Attention all staff, code pink labor and delivery room 403.' Code pink is a medical emergency for a child, like code blues are for adults. I wonder if Mark is involved in that. I found the next weird object on our hospital scavenger hunt. If you're wondering where all the vuvuzelas went from the South Africa World Cup... They are in hospitals as 'wet floor' signs. Yay, there he is. Okay, so clearly it's been a busy night because like only we're going to see each other at this time. But I heard that code pink and I immediately thought of you. Was it one of the babies for the deliveries? Yeah, so I told you guys about the patient with the amniotic fluid stained with meconium and that we were worried about meconium aspiration syndrome. So this actually was what happened. So you know, went through the delivery and everything looked good, but as soon as the baby came out we noticed it was a little bit lethargic and it wasn't breathing as well, didn't have the right color. But fortunately as I mentioned we called the NICU staff, so they're right there, they're ready to catch the baby. We clipped the cord really quickly, handed the baby over to the NICU staff. And in the meantime, craziest thing: then mom starts having quite a significant hemorrhage. So we administered the appropriate medications, got that under control and in the meantime, I heard the best sound we could ever possibly hear which was this beautiful pink happy baby starting to cry. The pediatrician was just about to intubate. You know good timing for the baby's part. And it was just so nice. We're taking care of mom and I'm looking over and the baby is kind of giving me the side eye over from the little incubator over there. Everything worked out great. You know a couple minutes later baby is back in mom's arms and a happy ending to a bit of a crazy story. Oh my gosh, that's amazing. Oh, sick babies that is so hard for me. Especially like since I only see adults, that is... That is terrifying. Alright guys, so I just got a page from the emergency department. They've asked me to see a patient who had come in with urinary retention and was about to be discharged, but someone had the bright idea to do a CT scan and they found a massive mass inside the lower abdomen. So we're gonna take a look at that imaging and we're trying to figure out what we want to do with that. Alright, so I just discussed the case with my supervisor. On imaging it looks like it's a cystic teratoma and the plan is actually to take her straight to the operating room to first off see what's going on exactly and then possibly actually remove the cyst. A teratoma is a type of tumor that contains multiple different types of tissue, sometimes including teeth and hair. This one doesn't look malignant, but we won't know for sure until the pathologists take a good close look at it. Okay, um... So I just got woken up by a page and it's from the emergency department, so I'm just gonna call them now. Hi, it's Siobhan from internal medicine returning a page. Sure, no problem. Yeah, yeah. I'll be right down to see. Okay, thanks. Bye. Okay, so this is the patient who has had quite a rise in her creatinine, which is a measure of the kidney function. So the question is: Why is that happening? And she certainly needs to come into the hospital because of it. And we'll find out some more information once we're actually down there, talk to her and look at the blood work. Okay, so this patient had a course of antibiotics for pneumonia about a month ago and then has developed profuse diarrhea since then. So I wonder if those are connected. There is an infection called C.diff where you're predisposed to it if you've had antibiotics recently, so we'll test for that. In the meantime we're gonna give lots of IV fluids to try to rehydrate and help the kidney function. But as I'm going upstairs, I want to check on that patient who had the aspiration and see how he's doing. Okay, so he's actually doing quite a lot better. Still on a lot of oxygen, but he's not breathing as heavily. I'm still really glad that his wife was able to come in and see him tonight. I think that makes a huge difference. It's still very much touch-and-go and yeah, tough situation. It was nice to be able to talk to her just now. Um, okay. I don't know. I'm so nervous to say 'let's go to bed'. I think we should go to sleep. I really have a feeling this is going to be good. Hey guys, so I just handed in the call room key and the pager. I'm a free man. Last night was crazy, babies flying everywhere, but happy endings all around and I can't wait to get home back into my bed. And I know Siobhan is going to be handing over in a couple of hours and then she'll be joining me then too. It was great sharing the shift with you and until next time. Bye for now! Wow, I feel so much better having gotten a little bit of sleep. I really hope that Mark got sleep. Oh my gosh, it's just kind of hitting me now. Like yes, I need to hand over, but after that I'm done. I'm done with my call shift, I'm done with my internal medicine residency. It's really not sunk in yet. I think I'm gonna have to do another video thinking about this, because it... It's just crazy. My brain can't process it right now, it doesn't feel real. Yeah, so just like within days I'm starting my rheumatology fellowship. Oh, this is so weird. It does not feel real. And I kind of miss it already. Like I love internal medicine, I definitely want to keep practicing internal medicine going forward, but wow! This is crazy! Okay, I feel like I'm not making sense, I'm too tired. Okay. Um, this is wild. Anyway, if you guys want to see more videos like this, interested in seeing what the journey is going to be like in rheumatology, then be sure to subscribe! Say hi in the comments below, I love hearing from you guys. And then otherwise I'll be seeing you in the next video. So bye for now.
