Did I really just do that?

I'm back in the ER for 2 months straight! That translates to 4 weeks of day shifts and 4 weeks of night shifts. My merciful chiefs have split up the nights so that I work 2 weeks of nights, 4 weeks of days, and then 2 additional weeks of nights. I just finished working four 12 hour night shifts in a row. By the time I count in checkout and the drive to and from work, I'm only home for about 10.5 hours each day. I have been tired but okay, but after work today, I came home and crashed. I've been go-go-go for the last four nights, and I am beyond thankful that I'm not bad for a fifth night in a row!

As a second year, I'm responsible for making sure the traumas and critical patients are covered. I was definitely terrified of this when I started second year, but I've now realized that I have sufficient back-up and have learned enough to feel comfortable working with the sickest patients. Our nurses, techs, and respiratory techs are AWESOME and help me out so much.

I'm working on becoming proficient in my procedures and have gotten to do a few laceration repairs and lumbar punctures (spinal taps) over the last several nights. We are supposed to be signed off on lumbar punctures (or LPs) as interns, so I have been "signed off" for a while and am allowed to perform them without being observed. Unfortunately, I have had a run of HARD taps for the last few months ... so hard that people with more experience me have not been able to get these taps either. I know that should make me feel better, but my self-confidence has been shot. The most frequently tapped patients are little babies less than 2 months old who are undergoing a work-up for sepsis, but we also tap older children as we see fit according to their clinical picture and our index of suspicion. My personal feeling is that the little babies are easier to tap due in large part that it's easier to hold a baby still than a big squirming kid still, but even in babies, performing a tap can still take a while even if you do everything perfectly. A few days ago, I tapped a four year old; while it took some time and a little help from our fellow, I still got it on the first stick! I have been feeling a little better about my ability after that.

Last night a 4 month old needed a tap, so despite my nerves, I set everything up and got the baby into position. I cleansed and prepped him and felt one last time for my landmarks. I slipped the spinal needle in where it was supposed to go ... and beautiful clear fluid immediately came out. The clinical tech who was holding the baby laughed at me when it was all over because of the look of joy and surprise that washed over my face. I was done with the entire procedure in less than two minutes, by far the fastest I have ever done and, according to the tech, the fastest he has ever seen done by a resident. The analysis of the fluid showed that it was a near-perfect tap and actually provided us with essential information in treating this patient. I was grinning ear to ear when I finished. I'm back, baby!!

I was still riding off the high of rebuilt confidence when my shift ended shortly after 7, so I expected to have trouble falling asleep later. Ha ha ... apparently the adrenaline wore off because after I showered and ate my first meal in 14 hours, I was asleep within 30 minutes and slept for seven hours straight. I'm extremely thankful that I have tonight off because tomorrow I will have clinic at 1 PM and will then work my 12 hour ER shift starting at 7 PM, and I still have more sleep on which to catch up. I'm actually looking forward to tomorrow night's shift; I'm back and ready to roll!