26 HOUR CALL SHIFT: Day in the Life of a Doctor, INTENSIVE CARE UNIT

Morning guys. I’m Siobhan, a 3rd year medical resident. Right now I’m heading to the hospital to start a 26-hour call shift in the ICU. So we’re going to be dealing with the most critically ill patients in the hospital and I’m gonna be telling you all about it. Each morning in the ICU we meet in the conference room and then meet with the doctor who was on call to find out what happened overnight. Then we gather as a team to see each patient together. We stand with our portable computers and desks, discussing every aspect of patient care. Today our team includes the bedside nurse, pharmacist, dietician, respiratory therapist, 4 residents and the attending physician. These are the sickest patients in the hospital. Often they’re hooked up to life support with breathing tubes, which is why we spend so much time with each patient. These discussions on rounds are fascinating, but to be honest it takes a long time and it could become pretty exhausting and even a little bit painful standing for so many hours. Okay, so it’s 2 p.m. and we just finished rounds. Like this was seeing 14 patients over like 5 hours. We’re all exhausted. I’m so hungry. I really wish I’d eaten breakfast this morning, so now I definitely need to get lunch. I’m starving! Okay, so the rest of the afternoon has been pretty relaxed actually. We had some teaching, we went over some new big trials that have come out in the IC literature, we finished up our notes, chatted as a team. So nothing major. But now it’s 8 o’clock and guess what?! We go on rounds again. Which means that we’re gonna go walk around, see all the patients again and see what’s happened throughout the day. Have there been any changes? These are some of the sickest patients in the entire hospital, so things change quickly. Which is why we actually see patients frequently, many times per day. Evening rounds are a lot faster. We’re mostly following up on tests that have been done during the day, ordering bloodwork for the morning and then trying to anticipate any issues that might arise over night and trying to deal with them early. Now we’re done with that, so it’s time to find the ICU call room. And we’ve got anything that we might need: a fan, computer, flashlights for emergencies, Saudi Journal of Medicine 2017 very up-to-date and of course the bed, which I really hope gets used tonight. Hey, this is Siobhan from ICU returning a page. Hi Mary. And how much oxygen right now? I’ll come up and meet you. We will see the patient together and then figure out what to do. So I was just paged by one of the CCRT nurses, that’s the critical care response team. So these are very highly trained ICU nurses who respond to patients who are sick up on the ward. And the idea is that they can identify who probably needs to come down to the ICU early, so that they can get the care quickly and then hopefully getting better. So I’ve been called because there’s a patient who is very hypoxic, meaning they’re not getting enough oxygen. I’m going up to see them right now in the ICU. I’m always worried if someone isn’t getting good oxygen in, do we need to put a tube down their throat? Do we need to intubate them? We’re gonna find out. Walking into the room I can see the patient is receiving high flow oxygen and she’s clearly feeling short of breath. Her heart rate is a bit elevated at 120 beats per minute, but luckily her blood pressure is normal. I’m ordering a stat chest x-ray and blood work now. I’m also gonna see if one of the nurses can put in another IV, so that we can easily give medications today. So this patient is really not doing well. They’re on 100% oxygen, so we can’t give any extra oxygen. She’s using all of it at this point and the x-ray looks like there’s a collapsed lung, so you can imagine she’s not even able to get very much air in. So at this point we definitely need to bring her down to the ICU and I’m gonna call my staff physician at home as well as the ICU fellow on call to be able to consider the next options, which may be something called bronchoscopy. So actually taking a camera, going down into the lungs… Not me, like that is not something that I’m qualified to do, but I will watch tentatively and then trying to figure out what’s blocking that lung. By the time the patient was transferred down to the ICU, the staff intensivist had already come in from home. We prepared some of the sedating medications for the procedure and then got started with the bronchoscopy. So putting the camera into the trachea and then down into the lungs we were able to see that there was a lot of thick, white mucus and that had plugged up her lung. So we were able to suction it back and then help her breathe a lot better. This is likely related to infection, probably a pneumonia. So we’re starting up antibiotics and then watching her really closely overnight. It’s so funny in medicine people always say: ”Oh, is the patient sick?” And you think: ”Uh, they are in the hospital. Aren’t all patients sick?” But this idea… There’s this idea of like sick or not sick that you kind of develop in medical school that is so incredibly important and I mean, I’m sure I’m still figuring… Page. Okay, let’s do this. Hi, this is Siobhan from ICU returning a page. Oh yeah, I did hear he was coming. I just didn’t know what time the OR was gonna finish. Great. Yeah, I’ll be right there. Okay. So this is the patient who’s just coming out of the operating room and they need to come to the ICU here to be monitored overnight. So the anesthesiologists and the surgeons should be just rolling in now with the patient, so I’ll meet them at the room and be able to get all the details from the surgery. I’m greeted by the general surgeon who explained that they repaired a bowel perforation in the operating room. The OR apparently went smoothly and there was really minimal blood loss. I then chat with the anesthesiologist, who warns me that the patient has a difficult airway. Meaning it’s really difficult to intubate them because of his anatomy. So that’s definitely something that I’m going to be passing on to the morning team. For now I’m gonna continue his IV fluids, antibiotics, give him some pain medications and then overnight we’ll be watching for any bleeding and make sure that his urine output is good. Don’t think I realize how incredibly thirsty I am until I actually started drinking water on call. My kidneys will thank me. Oh my gosh, I’m actually so tired at this point and I’m so convinced that the pager is gonna go off. I’m like dreading it. So… Okay, positive thoughts. I’m gonna try and get a little sleep and hopefully I won’t be seeing you guys until the morning. Okay. So I just got paged about a patient who’s in the emergency department who apparently needs to come to the ICU. Sounds like they’re in septic shock right now, which is really dangerous. So do I see them right now? This patient came to the emergency department feeling generally weak. The emerge doctors found his blood pressure was dangerously low, yet a high white blood cell count and a fever. So first thing is to try giving IV fluids to bring up that blood pressure and the emergency physicians did that. They gave him almost 3 liters of IV fluids, but his blood pressure is still low. That’s why they called the ICU. So at this point we’re going to start a new medication called Levophed. Which will help to bring up his blood pressure by causing constriction of the blood vessels. It’s now 7:30. So I’m gonna get up and look at morning blood work before the team gets here, print out some lists. But when my alarm went off I had no idea where I was. So much more different than having the pager going off. I was so confused. It feels so good to be home. Can’t wait to get into my pajamas, curl up in bed, sleep for as long as I can without an alarm and no pager. Anyway, if you guys find that the ICU is exciting or you have more questions about it, I actually have a whole playlist for the past 2 years when I’ve done ICU rotation. So take a look at that and then leave comments. I’d love to hear from you guys and otherwise, I’ll be chatting with you in the next video. So bye for now!

100 comments

  1. Please post more I love watching your videos! My fiancé was in the ICU for 2 weeks he was in a serious accident so it’s cool seeing these video! I remember learning about all the different things your talking about in this video.

  2. I’m a new ICU nurse and two of the patients you described were pretty much exactly the type of patients I took care of this weekend lol! What a coincidence! Thank you for your videos and all the teachings! It really helps a lot! ❤️

  3. I’m so curious about your call shifts. When are you allowed to take breaks? When are you allowed to sleep? How is it all structured?

  4. Just recently got out of the Hospital after having a collapsed lung, why does YouTube recommend me this Video.. ,seems they know a lot more than I thought 😂 but nice to see this view from the medical Team side. Your voice is really calming and nice to hear.

  5. Hello! I just found your channel and I am completely in love and hooked. It is so nice to see a young professional who is enthusiastic and positive about their work. It is really inspiring for soon to graduates like myself.

  6. Questions: how do doctors decide what patients need to be seen? And how do you remember what patients need to be seen if there’s an emergent case in the way.

  7. Omg I love watching your videos. And just the way you are sooooo excited about your job and sharing a day in your life is awesome. Feeling inspired to become a nurse and maybe one day meet the awesome person you are ❤️❤️ hope to hear from you.

  8. In nursing school there was a “catch phrase” so to speak about levophed. It was “levophed, leave them dead” – sounds awful. But in pharm as you’re learning all these new terms and such catch phrases help. Our instructor had been an ICU nurse for almost 30 years and said that most all her patients pass if their bp has tanked that bad and won’t come back up…to this point. Hope that isn’t the case for your pt!

  9. I’ve been watching since you were a first year! I’ve gained so much knowledge from just watching your videos. Thank you!

  10. i don't think no one asked and it's probably a dumb question, do you get paid to sleep as well? cause you're on call… i would assume?

  11. I love your videos. My mom is a retired CNA and she always told me interesting stuff. I get anxiety at the doctors a lot but this calms me down. Thanks

  12. Really enjoying your videos. Not sure if you’ve talked about this but how do you deal with death. I get that you don’t bring your work home but I can’t seem to let it go and move to on. Maybe I’m hyper emotional, I don’t know.

  13. Hi I’m just new to this channel and I am genuinely fascinated. I’m just curious to know why do resident doctors need to work for 26hours straight?

  14. I’m so curious and you’ve made me so motivated to get into medical school, is there a possibility that you can get into med school as an enrolled nurse ? Love your videos so much and Thankyou so much for being such an amazing doctor and motivating so many people to follow their dreams

  15. I appreciate that you are doing these vlogs. I homeschool my 9 year old girl. I've been saving some of your vlogs about diet and nutrition for a unit on nutrition.
    These videos are great for young people who want to go into the medical field. Just wanted to let you know you are helping homeschoolers and people who wish to introduce subjects they don't get in traditional public school.

  16. I still never got use to 2nd year coming out of your mouth.. now 3rd year ?!?! Where does the time go……. congrats you’re an amazing doctor ! Love the videos

  17. Icu nurse from Germany here 🙂 Working with ecmo, nitrogen monoxide respiration… the icu is specialized for heart and thorax diseases. ICU is a Challenge sometimes but worth it.

    Sorry for grammer mistakes.

  18. I had a collapsed left lung in 2014. It was completely collapsed and I couldn’t get no oxygen really. I had 3 surgeries and 1 procedure done on me at that time. One of the surgeries I had I did die and came back to life. I spent 23 days in the hospital

  19. Your channel is so much better than the medical stuff I see on TV.. definitely subbing to your channel! Question (this may be a good one for a future Q&A video) Just curious… How do you approach a dying patients family about organ and tissue donation?

  20. I was in the ICU for weeks. I had AVM (Arteriovenous malformation). I had brain surgery at 14 and I’m now 16. Still having some problems ):

  21. Your videos are so motivating to me! I want to become a surgeon, but I'm so lazy and undisciplined… I'll try my best to become like you!

  22. i was a patent in the icu in 2017 i have a lot of gi issues and i had to have 75% of my stomach taken out i also have seizures and when i was in the recovery room the said that i went into statis they said i had about 3 to 5 seizures in a row now i have trouble walking cause of the seizure and i use a wheelchair r walker

  23. When I read the text "collapsed lung," I thought of what happened to a fellow student during a break at school. He fell on his back, and his lungs collapsed. Fortunately, a school assistant with medical knowledge was present. She got him to raise his arms which, as far as I know, enabled him to breathe again. I do know that he survived the ordeal.

  24. I am truly grateful to all the nurse that take care of patients in the ICU and hospitals. I remeber my mom had meningits and we had to take her to the emergency room then to ICU. If those nurses weren't there my mom wouldnt have been alive. Thank you Hamad Hosipital Qatar

  25. Love your videos! I'm a unit clerk in Emergency in one of my city hospitals, and I love my work. Do you have unit clerks in your hospital? I feel so honoured to work with people I admire so much and get to support!

  26. This is kind of unrelated, but I was wondering if you would be willing to a video about the laboratory. Not many people are aware of medical laboratories the and processes involved. I think it would be interesting hearing the perspective of a different job role/position within the hospital.

  27. I was in ICU in 2012 after my head injury, luckily i survived with minor setbacks, but will NEVER be 100%, I'm alive , that's the main thing

  28. Hello! Like I said in the video from two months ago, I think the work that you do for patients is so awesome and I hope you continue helping them! Though I don't want to be a doctor, (for reasons of not being good with blood) I want to help support all doctors who take their job seriously and work long shifts like you do. Thank you again for doing what you do.

  29. How can you work for 26 hours and still look so beautiful? I look like I got hit by a truck after I sleep for 10 hours, let alone being AWAKE for the better part of 26!

  30. In regards to your feet hurting after a while, when you showed your feet when you were standing neutral, I could see your ankles rolling inwards, the word escapes me at the moment, but basically you need better support in your shoes. Stay away from Skechers, check support in shoes by bending and twisting them. If they flex more an 2 cm, and twist at all, there is not enough support. My recomendation is a brand called Merrell, or put Birkenstock insoles into your shoes. I work long hours, though nothing as crazy as yours, and I can't live without my Birkenstocks, as I have the same problem as you, with my feet turning inwards, or pronation, I believe. Just thought I could help you out a little. I work in a large shoe store chain, and love using my product knowledge that I have gained since I started in May to help someone (especially a fellow musician) out!

  31. Hey! Love your videos! How are you able to record your videos in the hospital? I would think they wouldn't let you because of privacy reasons

  32. The longs hours are about hazing new doctors. The powers that be are showing clear signs of sadistic sociopathology when they force doctors to works these crazy long shifts. The barbaric practice of making doctors work long hours must stop. The average workday is too long as it is, the workday should probably be shortened to about 5 hours.

  33. Hi shavan…i really dont know how to spell ur name…well i am a medical student in india and i am planning to do my residency in internal medicine in US…so do u have any indian friend who is doing residency at ur hospital ..if u have can u make a video on their experience…it will mean a lot…and i really enjoy ur video

  34. lmao the US medical residency system is straight garbage. 26 hour shifts are incredibly dangerous for the patients and the residents own health. Statistically speaking, 2000 to 3000 patients die every year directly due to sleep-deprived medical staff. Research has proven that sleep deprived medical staff are 36% more likely to make a dangerous mistake such as prescribing the wrong dose of a drug, leaving an implant in the patient's body during surgery, and a 400% higher chance of wrong diagnosis. US medicine residency is pathetic

  35. A ridiculous and unsafe number of hours to work. Then again, if it were in the typical emergency room I think the doctors are actually napping most of the time. Must be. Four hours in an emergency room and you see the doctor for only a couple of minutes. 🤣🤣🤣

Leave a Reply

(*) Required, Your email will not be published