“This Is Fine” Redux: A Hepatic Recap

I have survived.


My typical rotation recap job is to point out some funny things that happened, highlight that I learned a few things I think are cool, and then to wrap it all together in a nice bow by saying some variety of “it wasn’t that bad.” I will attempt to accomplish the first two things here today, because it was absolutely that bad.

First, the good things.

I performed an epic number of central lines. This falls under the Doing Things category, and thus was something I enjoyed. For the nonmedical, a central line is a very large IV that yours truly, or a similarly credentialed nincompoop, crams into one of the big veins in your neck or chest or groin in order to deliver medicine directly to the heart. It is a fun procedure, although I do not know exactly why.

The exact number of lines I completed is lost, since there were a few days where there were so many, they all blended together into one sterile-gowned and sweaty mist.

In volume, there is expertise. It is weird to have some pride in my efficiency at jamming a huge tube into someone’s neck – I started timing myself for an extra challenge – but feeling good about my lining skills is about the only positive I can take away from the rotation, so please don’t begrudge me my Icarus-level morbid hubris.

Second good thing: the bar for elevating my heart rate and blood pressure – whether by anger, life threat, fear, or any other stress response – is about twice as high as it was before. I am somewhat sure that I could stand in front of theĀ RevenantĀ grizzly bear and calmly accept my imminent and very painful demise; I imagine the feeling is akin to what I felt before taking signout on a night shift.

But say the words “liver nights” to me and my hands start sweating.

Third, I was wrong about the notes. The only notes you write on the liver ICU are for new admissions. The progress note, which is thoroughly useless except for billing purposes, is completed by the extremely overworked fellow.

Now, let’s get on to the good stuff. What you came to read. The bad things. Starting with, of course, liver nights.

I was on the liver ICU for 2 weeks. I worked four consecutive nights in the middle. Not bad, right? We ER people do night shifts all the time, and we are idiots. How hard could it be?

The answer is “extremely fucking hard.” I am not exaggerating when I say the four liver nights I worked were the four worst nights of my residency. Even my most benign liver night beat out that miserable 30-hour call night on medicine that ended with me locked out of the sleep rooms at four in the morning by a considerable margin.

And I cried on that 30-hour night.

Walking knowingly in to a liver night carries with it the same spectral response as a French aristocrat walking to the guillotine in front of a crazed Robespierreian mob. It’s all five Kubler-Ross Stages of Grief, held simultaneously in your brain:

  1. Denial: I can’t believe the hospital makes me do this.
  3. Bargaining: Maybe I can ask to have the nurse practitioner every night.
  4. Depression: I need Zoloft.
  5. Acceptance: My life sucks. I still need Zoloft.

The night shift on LICU is so awful because in addition to taking care of the 23 unstable ICU patients, you also cover the “liver floor” – about sixty patients with varying stages of liver disease – and admit new patients from the ER. The day team hands you a phone at around 7 pm and flees, leaving you completely by yourself. Your backup, an exhausted and overworked transplant surgery fellow, is at home trying to sleep.

It is a zoo. It is a zoo where some 12 Monkeys-inspiredĀ pranksters have opened all of the cages and simultaneously started multiple trash fires all over the grounds. You, the night resident, are completely alone to weather this turdfest of a storm. It puts the banner of this site into a whole new context.

(Props if you understood the 12 Monkeys reference.)

During my first night shift, there was a moment where I took off my pager, phone, and personal phone, left them all on a desk, and hid in the bathroom because I needed two minutes – just two minutes! – of silence.

After sixty seconds, a nurse knocked on the door. “Nate? You’re not answering your phone and we need you in room 57.”

(I hated room 57.)


On my first night, we admitted nine patients – three to the ICU, three from the ER, and three that somehow magically showed up in a hospital bed from somewhere else. (This happens not irregularly on this service, for no reason at all.) I transferred two extra “floor” patients to the ICU because they got worse. I called my sleeping fellow three times to ask for help. And I ate a handful of trail mix on “midnight rounds,” and was promptly yelled at by the charge nurse for violating the policy against feeding the residents.

On my fourth night, I walked in to work with both a double-meat Chipotle burrito and a donut. I ate them both during signout and slipped comfortably into a carb-induced haze that let me coast through the first thirty or so fires of the night. By the time the day team arrived at 7 am the next morning, I had no recollection whatsoever of the previous night, except that I think someone died (expected) and someone else got a little better (unexpected). I was unclear who was who when I signed out the list.

They’d figure it out eventually.

PS: if you’re in my residency and reading this, I’m exaggerating.* Don’t worry. You’ll be fine.

*(but only a little)

One thought on ““This Is Fine” Redux: A Hepatic Recap

  1. Pingback: The Residency Drowning Triad | crashing resident

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