A “Day” on Nights

A “Day” in the Life of Nights

2016 update provided by Eric Ness, CA2

1730: My fellow night resident and I arrive and are ready at the “Big Board” to meet with the Board Runner responsible for assigning cases and personnel to the rooms. We usually get assigned to rooms already in progress to help relieve our colleagues who have been working all day, although occasionally there are urgent or emergent cases to start at that time that we will do.  The next few hours will follow this pattern; as we finish cases, we’ll take a small break and then do the same thing for a different room or start the next case.  Over time, the non-call residents and then the other call residents of the day will gradually get relieved and be able to go home.

2030: One by one, the call residents’ cases are completed or they are relieved, and at this point there are only a few cases running. I’m able to take the code, consult/airway, and PACU pagers from the 2nd call resident who has been holding at least some of those pagers since 0700.  Eventually another case or two finishes and the 1st call resident is also able to leave.  While my colleague is still in a room finishing his case, I work on evaluating the late-posted cases for tomorrow.

2200: I get a call from the Transplant Surgery fellow: they have accepted a deceased donor liver for transplant, and the patient is on their way to the hospital. They would like to get the case started at about 0600.  I call our liver transplant attending on call to let them know and read about the patient.

Ness

Eric Ness, CA-2

0000: All of the previous days’ cases have finished, and today the urgent cases started in the evening have all finished, so my colleague and I are afforded some valuable time to relax and rest.

0100: A call comes from the MICU – one of their patients has worsening respiratory distress and they would like to us to assist with intubation. We get up to speed of the patients’ history and lab values and then head up to the MICU to examine the patient and prepare for intubation.  Once everything is set up, we call our attending and have her come upstairs to assist us.  Fortunately, everything goes smoothly, and by 0130 we’re able to make our way back downstairs to the ready room.

0200: We get another call – this time from a surgery resident letting us know that a patient down in the Emergency Department needs an appendectomy. Since fortunately both of us are still free, we work together to read up on the patient and prepare the OR.  Since I’ve been out of the ORs for a while, I volunteer to take this case and give my colleague the pagers.

0400: The appendectomy is finished and the patient is dropped off in the PACU. My colleague has already seen the liver transplant patient and set up the room, so at this point we both retreat to our call rooms to get a quick nap before the case starts.

0555: The liver transplant patient arrives at the front desk and is “checked in” by our team, the surgical team, and the nurse from the room. We bring the patient back to the OR and get ready to start.  There’s a lot to do in a liver transplant at the beginning of the case, so we’re fortunate that both of us are free to help one another get started.  Our attending and I induce anesthesia and intubate the patient while my colleague places a right radial arterial line.  I place a RIC catheter in the left arm while my colleague places a right femoral arterial line.  Finally we place a central line in the right internal jugular vein.

0700: All of this takes a while, and by the time we are done the resident assigned to the room for the day arrives. We sign out the case to him and make our way to the ready room, where 2nd call for the day has just come in to get us out.  We head home to get some more sleep and get ready for another day!