Another head bleed

Last night was my first time taking R2 call for neurosurgery, and incidentally one of the busiest nights for neurosurgery in a while. It's nice to hear the ER attendings muse "I've been here for 17 years, and I don't think I've ever seen neurosurgery get hit this hard."

Fan-frickin-tastic.

It starts with morning rounds at 0515. Head CTs and MRIs from the night before, followed by rounding on the service's 35 patients (we're light right now). ICU rounds, battling it out with the neurocritical care team regarding what we think is the best care for the patient. Then a casual breakfast in the otherwise chaotic day at 0700, followed by phone calls to the attending neurosurgeons giving them updates on their patients. This is probably the most stressful part of the day. You never know what they're going to ask you about their patients, making it seemingly impossible to have the right information ready for them. Lots of "uh..." "one second sir...".

And then it starts. A young girl with leukemia who bleeds into her brain. A devastating hemorrhage that's left her unresponsive and intubated. But we can give her a chance. Set up the OR, consult pediatric hematology, hang blood products to correct her platelets of 25 and crit of 12. Oh yea, and who has a white count in the 300s? Honestly. While the blood products are running and hemapharesis going to correct her leucocytosis I steal off to grab a bite to eat. It's lunch at 1400, not too bad. I sit down to a nice piece of salmon and corn bread, yum. Phone rings.

Me: "Yes Dr. xxxx? Products are running and hemapharesis going. Well I don't believe we can do that in the OR. No I'm not completely sure. Yes sir."
Dr. X: "Your patient is dying, go go go!"

I got one bite of my salmon, and in trying to save my soda for the road, watched it explode on the cafeteria floor. It would have been more tragic had I known the next time I'd get a chance to eat would be 0330 the next day.

Push blood products. Deliberate best course of action. Coordinate OR time with hemapharesis. Rush patient to the OR. Pager rings: code trauma. Another CT scan, another head bleed. As the first case finishes up we wheel the next one through. 4 consults pending in the ED. Head bleed, head bleed, head fracture with head bleed, new brain mass... Phone calls from transfer centers asking to send patients with ventriculoperitoneal (VP) shunt malfunctions. Another consult: 90 year old Chinese male with ... head bleed. Hey, does anyone speak Chinese???

32 hours, two back to back red-lines, 11 consults, 0 sleep. I signed up for this? Stupid stupid stupid...