Cross Cover Emergencies

I was finishing up my second week of my fourth year medical ICU rotation when I got my first cross-cover call. The prior two weeks had prepared me to expect life and death emergencies; just a few hours prior a Ludwig’s Angina patient had pulled out her own breathing tube. It was nearing the end of the night and amid the regular beeps and clamor of the ICU unit, I heard a ruckus at the end of the hall. I learned quickly that the ICU is not a quiet place, and people shouting was not completely out of the ordinary.

“Can you take this one?” the intern mouths to me and hands me his pager as he’s on the phone with a consult. All the pager says is “Room 612.” Signout hours earlier had been a blur. I scanned the handoff sheet and found 612: “92-year-old woman here for altered mental status” – which could be anything. Feeling quite like a child soldier gearing up for battle, I slung my stethoscope around my neck and headed down the hall. The yelling got louder until I came to stop in front of room 612, the source of the commotion. Outside the door I was met by the nurse who appeared to have at least fifteen extra years of experience on me. Exasperated, she gave me a momentary smirk as if to say, “great, they sent the student”. I couldn’t blame her. She quickly regained her composure and informed me “Ethel is sundowning hard. She spits out all of her pills, including her home sleep aid, Zyprexa. Can we give her IM Haldol?” I was acutely aware of the absurdity of the situation: the nurse, who had seen about a thousand such patients was asking me, who had been in the ICU for all of two weeks, for advice.

“Help! I want to go home!” I heard from the room, confirming the nurse’s assessment. Why do they always have to yell “help”? It feels like we’re holding down and torturing a prisoner of war, which in this case didn’t seem quite off. In the room, I saw an older woman, presumably Ethel, being held down by a nursing assistant and screaming. “I can see she’s quite the handful,” was my unhelpful, noncommittal response. I came closer to Ethel and for a moment as she watched me walk in, she quieted, as if she was hoping I was reinforcement to rescue her from her prison. She was thin and had curly white hair; she could be any other elderly woman, but this woman was depending on me to help her. Completely unsure of what to do, I took the momentary pause to speak directly to our patient, “Ethel, we’re here to help you. What do you want?” “Water!”, Ethel exclaimed. “Ethel,” I responded, “We can get you some water. Would you be able to take your pills with the water?” She responded with a terse, “I’m thirsty!” Quickly, the nurse popped the Zyprexa in her mouth and followed it with a sip of water. Ethel swallowed without complaint. One by one, the nurse repeated this with the rest of her medications. When she was finished, Ethel continued to appear restless, but quieter. “Well,” the nurse remarked, “If anything else comes up, we know how to get a hold of you.” I know that in future cross cover “emergencies” I won’t be so lucky as to always encounter an issue that solves itself, but I left Ethel’s room feeling a soldier at least slightly more prepared for the oncoming war that is intern year.