Stories from the VA

[cbrons]

Be me, a resident
Work night float at VA
Be accosted by an R.N. at 4:00am
"Hey dr levophed, there was an order to check mr. Johnson's troponin at 7pm."
Me: "okay. And?"
"Well i forgot to do it."
Me: ".......okay"
".... so its 4am."
Me: nodding
"So.... Do I still have to draw it?"

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[Psai]

Sounds like the day team should have gotten the trop earlier so they can follow up before signout. Why should the night resident have to call the covering cards fellow at night

 

[alternatecharacter]

Sounds like the day team should have gotten the trop earlier so they can follow up before signout. Why should the night resident have to call the covering cards fellow at night

What? We admit people all the time near the end of the day and have to check them overnight. Our VA is notorious for never checking labs overnight. You have to call the phlebotomist or call a rapid, otherwise it's not getting done.

Why should he have to call a cards fellow overnight? Unless it's a STEMI you don't need a cards fellows to manage ACS overnight...

 

[alternatecharacter]

As for VA stories, I have a million of them. My favorite was walking into a "Code blue" and no one is doing chest compression's. They found him without a pulse, called a code blue, and then were just sort of standing there in shock. Has happened to multiple residents.

 

[WheezyBaby]

Sounds like the day team should have gotten the trop earlier so they can follow up before signout. Why should the night resident have to call the covering cards fellow at night

Great, lets trend trops q15 minutes so the night team doesn't have to be arsed with patient care, don't know why I haven't thought of that

 

[AdmiralChz]

4:30 AM, PGY-3 overnight call for anesthesiology

*Code Blue/Airway Pager goes off*
Me: Yawn... you paged?
RN: Dr. Chz we need you QUICKLY to the 4th floor it's an emergency

I run up there with an airway box, rub into the room to find...

RN with clipboard checklist: Good morning Dr. Chz, this is Mr. Jones and the RN just found him unresponsive.
I look over at Mr. Jones, who is a CPR mannequin and appears very plastic for 4:30 AM.
RN with Clipboard: Dr. X here (cross cover medicine PGY-2) has requested you for airway assistance.
Respiratory Therapist runs in, out of breath, sees Mr. Plastic Jones: "Oh, **** no!!" *Throws down equipment, walks out cursing.
Me: Uh, ok. *Intubates mannequin*
RN with Clipboard: Wait... you didnt assess the situation or look/listen/feel for breaths!
Dr. X: Mr. Jones has a rare variant of "plastic Mortis" following an infection with Streptococcus "GoF***YourselfOccus" it's a terminal condition.
We both walk out, RN frozen with mouth half open.

 

[Iso4ane]

4:30 AM, PGY-3 overnight call for anesthesiology

*Code Blue/Airway Pager goes off*
Me: Yawn... you paged?
RN: Dr. Chz we need you QUICKLY to the 4th floor it's an emergency

I run up there with an airway box, rub into the room to find...

RN with clipboard checklist: Good morning Dr. Chz, this is Mr. Jones and the RN just found him unresponsive.
I look over at Mr. Jones, who is a CPR mannequin and appears very plastic for 4:30 AM.
RN with Clipboard: Dr. X here (cross cover medicine PGY-2) has requested you for airway assistance.
Respiratory Therapist runs in, out of breath, sees Mr. Plastic Jones: "Oh, **** no!!" *Throws down equipment, walks out cursing.
Me: Uh, ok. *Intubates mannequin*
RN with Clipboard: Wait... you didnt assess the situation or look/listen/feel for breaths!
Dr. X: Mr. Jones has a rare variant of "plastic Mortis" following an infection with Streptococcus "GoF***YourselfOccus" it's a terminal condition.
We both walk out, RN frozen with mouth half open.

If no one was doing CPR, I would been 'He's clearly dead. Cold and no pulse. Bye.'

 

[ThoracicGuy]

4:30 AM, PGY-3 overnight call for anesthesiology

*Code Blue/Airway Pager goes off*
Me: Yawn... you paged?
RN: Dr. Chz we need you QUICKLY to the 4th floor it's an emergency

I run up there with an airway box, rub into the room to find...

RN with clipboard checklist: Good morning Dr. Chz, this is Mr. Jones and the RN just found him unresponsive.
I look over at Mr. Jones, who is a CPR mannequin and appears very plastic for 4:30 AM.
RN with Clipboard: Dr. X here (cross cover medicine PGY-2) has requested you for airway assistance.
Respiratory Therapist runs in, out of breath, sees Mr. Plastic Jones: "Oh, **** no!!" *Throws down equipment, walks out cursing.
Me: Uh, ok. *Intubates mannequin*
RN with Clipboard: Wait... you didnt assess the situation or look/listen/feel for breaths!
Dr. X: Mr. Jones has a rare variant of "plastic Mortis" following an infection with Streptococcus "GoF***YourselfOccus" it's a terminal condition.
We both walk out, RN frozen with mouth half open.

Who's grand idea was it to do some training exercise in the middle of the night???

 

[Winged Scapula]

Who's grand idea was it to do some training exercise in the middle of the night???

But it wasn't the middle of the night; It was the middle of your shift right?!

 

[Raryn]

Who's grand idea was it to do some training exercise in the middle of the night???

VA does mock codes during all three shifts so all staff is tested, otherwise the night nurses would never practice. It's some kind of mandate from the OMB or one of the other federal watchdogs.

It is actually a reasonable policy IMO. Sucks as a physician who also works days, but real codes can be rare enough you want the night nurses to practice.

 

[ThoracicGuy]

VA does mock codes during all three shifts so all staff is tested, otherwise the night nurses would never practice. It's some kind of mandate from the OMB or one of the other federal watchdogs.

It is actually a reasonable policy IMO. Sucks as a physician who also works days, but real codes can be rare enough you want the night nurses to practice.

And did they really need the night call physician to run up there? They could have an admin stand in for the MD for their little pretend exercise.

 

[AdmiralChz]

But it wasn't the middle of the night; It was the middle of your shift right?!

Yes, that's basically what they said. "All shifts need practice!" I believe the RNs worked in 12 hour shifts, I asked why not do it at a more reasonable time like 8 or 9 PM. They just stared at me blankly.

 

[Smurfette]

VA does mock codes during all three shifts so all staff is tested, otherwise the night nurses would never practice. It's some kind of mandate from the OMB or one of the other federal watchdogs.

It is actually a reasonable policy IMO. Sucks as a physician who also works days, but real codes can be rare enough you want the night nurses to practice.

I didn't train at a VA, but I did train at a county hospital. Most of our codes actually occurred between 4 and 6 am when the nurses finally went in to check patient's morning vitals before rounds began and discovered patients who died in the night.

One of my favorite stories was the 4 am code where the surgery night chief ran into the room to find a patient who was cool and in early rigor mortis and waved the rest of the team out of the room. The on-call anesthesiologist (a particularly high-strung "must teach at all costs" personality) showed up and was determined to intubate and try and resuscitate the patient. It ended as expected after a struggle to open the jaw. Interestingly, the patient was documented at 6 am to have normal vital signs despite awaiting transport to the morgue.

 

[Psai]

4:30 AM, PGY-3 overnight call for anesthesiology

*Code Blue/Airway Pager goes off*
Me: Yawn... you paged?
RN: Dr. Chz we need you QUICKLY to the 4th floor it's an emergency

I run up there with an airway box, rub into the room to find...

RN with clipboard checklist: Good morning Dr. Chz, this is Mr. Jones and the RN just found him unresponsive.
I look over at Mr. Jones, who is a CPR mannequin and appears very plastic for 4:30 AM.
RN with Clipboard: Dr. X here (cross cover medicine PGY-2) has requested you for airway assistance.
Respiratory Therapist runs in, out of breath, sees Mr. Plastic Jones: "Oh, **** no!!" *Throws down equipment, walks out cursing.
Me: Uh, ok. *Intubates mannequin*
RN with Clipboard: Wait... you didnt assess the situation or look/listen/feel for breaths!
Dr. X: Mr. Jones has a rare variant of "plastic Mortis" following an infection with Streptococcus "GoF***YourselfOccus" it's a terminal condition.
We both walk out, RN frozen with mouth half open.

I would have taken that clipboard, snap it in half and throw it in the trash

 

[Shikima]

I would have taken that clipboard, snap it in half and throw it in the trash

Destruction of Gov't property....

 

[MediCane2006]

I didn't train at a VA, but I did train at a county hospital. Most of our codes actually occurred between 4 and 6 am when the nurses finally went in to check patient's morning vitals before rounds began and discovered patients who died in the night.

One of my favorite stories was the 4 am code where the surgery night chief ran into the room to find a patient who was cool and in early rigor mortis and waved the rest of the team out of the room. The on-call anesthesiologist (a particularly high-strung "must teach at all costs" personality) showed up and was determined to intubate and try and resuscitate the patient. It ended as expected after a struggle to open the jaw. Interestingly, the patient was documented at 6 am to have normal vital signs despite awaiting transport to the morgue.

I have a very similar story from my residency days at the VA....it was my first code blue as an intern, and it was pretty interesting trying to intubate someone who was cold and stiff....

 

[d2305]

In the everyone is equal mentality of ACLS/AHA, let the nurse run the code as she has a card.

 

[Apollyon]

Two flavors of VA codes - 1. fell out of the wheelchair 2. cold, blue, and stiff on vitals signs check ("Prognosis: Negative") at 5:50am.

 

[WholeLottaGame7]

4:30 AM, PGY-3 overnight call for anesthesiology

*Code Blue/Airway Pager goes off*
Me: Yawn... you paged?
RN: Dr. Chz we need you QUICKLY to the 4th floor it's an emergency

I run up there with an airway box, rub into the room to find...

RN with clipboard checklist: Good morning Dr. Chz, this is Mr. Jones and the RN just found him unresponsive.
I look over at Mr. Jones, who is a CPR mannequin and appears very plastic for 4:30 AM.
RN with Clipboard: Dr. X here (cross cover medicine PGY-2) has requested you for airway assistance.
Respiratory Therapist runs in, out of breath, sees Mr. Plastic Jones: "Oh, **** no!!" *Throws down equipment, walks out cursing.
Me: Uh, ok. *Intubates mannequin*
RN with Clipboard: Wait... you didnt assess the situation or look/listen/feel for breaths!
Dr. X: Mr. Jones has a rare variant of "plastic Mortis" following an infection with Streptococcus "GoF***YourselfOccus" it's a terminal condition.
We both walk out, RN frozen with mouth half open.

This is the rare time when the RT is the one with the right idea...

 

[URHere]

We have an ED attending at our VA, who is notable for admitting about 60% more patients than everyone else. During the day it's somewhat buffered by floor attendings giving pushback. At night there's no way to refuse ED admits. Hence this gem.

We once had to admit a VA patient for "Altered mental status....versus sleeping".

Sleeping.

Dude was homeless and just chillin on the curb. Not sure which of us was more unhappy about being there.

 

[akwho]

We have an ED attending at our VA, who is notable for admitting about 60% more patients than everyone else. During the day it's somewhat buffered by floor attendings giving pushback. At night there's no way to refuse ED admits. Hence this gem.

We once had to admit a VA patient for "Altered mental status....versus sleeping".

Sleeping.

Dude was homeless and just chillin on the curb. Not sure which of us was more unhappy about being there.

Funny how many more garbage admissions you get with certain ED providers on staff vs good ones.

We had one ED attending at the VA who admitted a 23-year-old female with GAD otherwise healthy for ACS rule out, "because she was having trouble catching her breath and females have atypical chest pain." In reality she had run out of Xanax at home and was having an anxiety attack, which was the first thing she said to us when we walked into the room.

 

[FutureInternist]

Funny how many more garbage admissions you get with certain ED providers on staff vs good ones.

We had one ED attending at the VA who admitted a 23-year-old female with GAD otherwise healthy for ACS rule out, "because she was having trouble catching her breath and females have atypical chest pain." In reality she had run out of Xanax at home and was having an anxiety attack, which was the first thing she said to us when we walked into the room.

Isn't "good ER doctor" an oxymoron, even more so at a VA .

The one at which I did residency had several "1 year residency having, but somehow still allowed to practice "medicine"" docs who had carte blanche to admit whatever they wanted and the 3rd year IM resident could not block. .

Capped early with a bunch of easy admissions but during training it seemed detrimental to not get a full day's worth of learning.

 

[Trogghunter]

Let's see...

A patient died overnight and no one found out for at least 1 nursing shift. The nurses kept charting normal vitals and BP during the day, it was realized that he was dead at about 4pm.

Several years ago the patients in a 4 person room ran a code and supposedly a nurse was flagged down but said 'not my patient not my problem'.

An ICU nurse was seen and heard telling an awake and intubated patient to 'just give in and stop fighting it'.

I saw a nurse give a patient a cigarette.

A nurse refused to give lovenox to a patient because afternoon shift change was in 2hrs and she literally said 'I don't have time for that because my tour of duty is ending'. The patient had a submissive PE overnight.

 

[Apollyon]

Isn't "good ER doctor" an oxymoron, even more so at a VA.

And, there is is. SDN vets know what I mean.

 

[Raryn]

And, there is is. SDN vets know what I mean.

While the statement is a bit much, I will point out that the vast majority of VA "ER doctor"s everywhere I am aware of are internists. I don't know of any VA that requires them to be board certified in EM.

 

[VA Hopeful Dr]

And, there is is. SDN vets know what I mean.

Nice to leave out the winking smile that was attached to that quote, suggesting that the author knew what they were doing.

 

[Apollyon]

Nice to leave out the winking smile that was attached to that quote, suggesting that the author knew what they were doing.

Smilies mean bubkus. People know exactly what they are saying, with the smiley or without.

 

[BobBarker]

One of my first anesthesia rotations as a CA1 was at the VA. My attending was just out of residency and the surgeon had days until retirement. We did a endovascular aneurysm repair in the cath lab. Everything went great. The 3 of us and the patient are all in the elevator headed up to the PACU. The elevator suddenly drops around 10 feet. The door opens and we are between floors. It lowers slowly in a controlled manner and we are able to get out. All 3 of us look at each other thinking about how bad it would suck to die today.

 

[VA Hopeful Dr]

Smilies mean bubkus. People know exactly what they are saying, with the smiley or without.

I believe the expression is "poking the bear". You need to lighten up a bit.

 

[Arch Guillotti]

You need to lighten up a bit.

I think this is what you are looking for.

 

[Apollyon]

I believe the expression is "poking the bear". You need to lighten up a bit.

Last shift I worked, I said, "I don't care if I lose my license, I'll quit right now". I'm REALLY enjoying my Porch Rocker right now.

 

[VA Hopeful Dr]

Last shift I worked, I said, "I don't care if I lose my license, I'll quit right now". I'm REALLY enjoying my Porch Rocker right now.

I've had days like that. I hope said rocker is accompanied by a spirituous beverage.

 

[Apollyon]

I've had days like that. I hope said rocker is accompanied by a spirituous beverage.

Porch Rocker is Sammy Adams' summer shandy. I can't believe that it's only the third week in August, and the fall beer is already out. I got one of the last 3 12 packs of Porch Rocker at my local distributor.

I was supposed to work an extra shift yesterday, but, after my ****ty day, they got the boss to work it. I was actually happy when I got the word, extra money be damned.

 

[FutureInternist]

One of my first anesthesia rotations as a CA1 was at the VA. My attending was just out of residency and the surgeon had days until retirement. We did a endovascular aneurysm repair in the cath lab. Everything went great. The 3 of us and the patient are all in the elevator headed up to the PACU. The elevator suddenly drops around 10 feet. The door opens and we are between floors. It lowers slowly in a controlled manner and we are able to get out. All 3 of us look at each other thinking about how bad it would suck to die today.

Elevator Decapitation

 

[ThoracicGuy]

Elevator Decapitation

Catching Elevators

More on this...

 

[wholeheartedly]

Catching Elevators

More on this...

Well, if that's not motivation to get more exercise by taking the stairs ...