Surg Path is keeping me really busy. I've got plenty to post about, just no time to type it up! And now that I do have a spare moment, I want to write about my first week on call (from a month ago).
CP (Clinical Pathology) call is taken one week at a time by one resident in the program. Any call that has to do with a lab -- blood bank, clinical chemistry, microbiology, etc. -- goes to us. Most of these calls are about blood products. We have been triaging blood some at our hospital, as supplies are low for one type in particular. Transfusion reactions also get reported to us, and complicated blood bank cases are run by us for answers on what to do.
My first page (as I mentioned here) came at four in the morning and involved a child whose blood type test was sort of showing two different blood types, because he'd received many units of a blood type not his own at an outside hospital (with no obvious adverse effects, luckily). It also showed antibodies to his original blood type, presumably from the transfusion. The question was, what type of blood should we give from this point forward?
Now, the case wasn't super-complicated, but it wasn't simple. And I haven't rotated through blood bank yet. So I did what I ended up doing pretty much every time -- I called my attending. He was really nice and understanding, even though I wasn't able to answer most of his questions (since they were questions I didn't even know to ask the blood bank tech).
We decided to keep giving the same type of blood the patient had been getting. I *think* I understand all the details at this point.
Other complicated calls included a sickle-cell anemia patient with low hemoglobin whose blood sample was reacting to stored blood that it hadn't previously reacted to, making it difficult to find a match; a patient whose sample in the blood bank was reacting to blood similar to blood she had been sent for transfusion (this was harrowing); and an ER patient needing lots of blood with a very specific antigen set.
If those summaries don't make sense, it's both because I don't want to bore you with the details and because that's the best way I can describe the cases without starting to get confused myself. Needless to say, I will find call much much less stressful once I've actually done my blood bank rotation!
We got a few calls for transfusion reactions -- patient developed a fever, or a rash, or etc. after receiving blood products. These were typically straightforward.
At my program, pathology resident approval is required to give out a certain super-specific anti-bleeding drug. I got a request for it once, pretty early in the morning, from a surgeon. After spending half an hour getting all my facts straight and having the attending tell me to approve it, I called back and the surgeon had already left the OR, apparently not needing it.
Some blood tests also require resident approval. I had to authorize the ordering of a urine myoglobin test (the clinician wanted it stat, but it's a test that an outside lab has to perform for us -- sorry!) and a HIT antibody test.
Two other calls are worth a mention. Phlebotomy called us asking if we were OK with them drawing blood on a patient from above a tiny IV in their hand (which is tricky), since the patient's other arm was unusable. I contact the attending, and his response? Just draw it from a leg. Nice and elegant solution. Wish I had thought of that.
Finally, we had a call about a clinic patient with a critically low lab value. The problem? The doctor's information was nowhere in the paperwork the lab received. They had the patient's home phone number and asked me if I should call the patient directly. I decided it was easier to go into our EMR and get the doctor's name that way. Contacting him once I knew who he was wasn't too hard.
So, a lot of complicated calls, a lot of straightforward calls, and a couple minor calls. It started out slow (maybe one a night) but really avalanched toward the end. One night, I was busy fielding calls from midnight to 4 a.m. straight, including two at once at one point, and I didn't quite make it to 7:30 a.m. lecture that day.
Sure, I know any surgeons or OB-GYN residents are shaking their head in disbelief about how easy my call is compared to theirs. All I have to say is, that's one of the many reasons I signed up for pathology.
Stay tuned for one last post about my microbiology rotation, and then as many posts about surgical pathology as I can steal time to write.