I'm not sure what THAT is. It must be bad. No horrible. The patient is going to die! The patient is dying NOW! Ahhhhh!

At our institution we have a Rapid Response system that is in place for patients in distress, a precursor to the Code Blue of sorts. Apparently, taking care of patients before they actually "code" is a great idea. Something about better recovery or something if the heart doesn't stop. I don't know, I skipped that lecture. Our Rapid Response Nurses and the Respiratory Therapists who attend these are amazing. They know their stuff. Inside and out. Anytime I've poked my head in on these, I've been pleased with how things are going.

It absolutely never ceases to amaze me, however, how much the fear of the unknown dictates so much of what gets people in a tizzy in the middle of the night.

Best call of the night last night occurred at approx 1:32, give or take 30 seconds, not that I was keeping track. It was our Respiratory Therapist who had responded to a "Rapid" on a patient earlier that night and had done a excellent job. Basically, the little old man who couldn't have weighed more than 80 pounds was over-medicated. He woke back up to embrace the world once given a medication to reverse the effects of the benzo he'd been given. It's an amazing thing to see someone "come back" from what looks like the brink of death when given one of these reversal meds. Nonetheless, his blood pressure was also tanked when we first got there, despite him being outrageously hypertensive on admission only a few hours earlier. Since he had this acute mental status change on top of the fall in blood pressure, we ordered a Head CT to rule out a stroke.

1:31 am. I had dosed off for a wee minute. You know, had just dosed off. Was somewhere between the worlds of Reality, where my pager goes off every 15 minutes for hours on end, and the Dreamland of Rainbows and Unicorns, where pagers are absolutely outlawed with penalty of death if someone is.... Pager goes off. It's the Respiratory Therapist asking if I'd seen the Head CT of our little man from earlier that night.

"Nope, but Radiology called me to say it was unchanged since earlier today." (He was initially admitted for a syncopal episode and had gotten a CT.)

He pauses, "Oh, ok.... Well. But did you look at it?"

"Nope, hadn't gotten a chance yet." But. spoke. with. the. Radiologist. You know, the people who kinda handle that thing, I thought but politely did not say out loud.

Him, "Who's down there?"

Me, "Who's down where?"

Him, "In Radiology." (In other words, he's not buying this whole "no change" report.)

I tell him which one it is, and he tells me he doesn't know that Radiologist. (Yes, you're right! I do LOVE small talk at 1 am! Especially when I've been awake for 22 hours! Yay!)

Him again, "Did you see that big white stripe on the left going right across his brain?"

Me again, "No I haven't had a chance to look at it. I'll go look at it now and call you back." (No big deal, really, to put my glasses back on, slip my shoes back on, peel myself out of bed to log back onto the computer, then log onto the radiology program to double-check. the. Radiologist. After all: #1 I think there's an actual course on Head CT's in RT school, so what he's seeing is probably very bad. and real! and #2 I, the Radiology intern who has done exactly zero Head CT's in this month-long Radiology career of mine, needs to check. the. Radiologist's. work.)

I take a look at it. I call him back and at this point, despite my best efforts, am being a little facetious, "Do you mean the white stripe on the right side of his brain?" Him, "Oh. Well, the left side of the screen." Me, with a rather short tone, "The right side then. That's the petrous portion of the temporal bone." While I'll spot him the fact it does indeed look white (white=bad on CT because it could be blood; blood in the brain is suppose to be a bad thing, from what I've heard on the streets), it's a fairly obvious anatomy landmark even for me.

While I'm risking sounding like an insensitive jerk on here, if I don't poke fun of these things and try to laugh a little about them... at least keep some form of sense of humor.... my head is going to explode.