Tuesday, July 1, 2008

Typical reaction

So today was my first day as a Heme/Onc fellow. It is so much better (and different) than being a resident. Of course, I'm still pretty clueless about chemo reactions, drugs, etc. But that doesn't mean I can't be the fellow on call for the chemo room. Nope, it doesn't matter that it is my first day and I don't know anything. Go ahead, call me when you don't know what else to do because I do (ha, ha, ha).

The first page came around 10am (not bad at all). I had just finished rounding with the inpatient team and was really enjoying NOT being the resident. I even felt sorry for the intern (but only for a second). The nurse on the other line said, "please get down here we are having a reaction." So to the chemo room I went. I walked in and the nurse at the desk motioned me to the back of the room (this was my first time to ever visit the infusion room). The entire time I'm wondering how serious this is...what kind of reaction are we talking about? How am I supposed to know what is going on?

When I get to the patient, nurse Bill is standing over him. He is breathing fast w/ definate wheezing I could hear without a stethoscope. His his heart was beating fast and he was flushed from head to toe. His vital signs were stable and he was not in any acute danger. The following is the conversation I had w/ nurse Bill (thank God for nurse Bill).

Me: "What was he getting?"
Nurse: "He was 30 minutes into his infusion of carboplatim (I had to google how to spell it)"
Me: "Is this his first infusion?"
Nurse: "No this is his 3rd cycle."
Me (to the patient): "Has this ever happened before?"
Patient: "No"
Nurse: "The typical carboplatim reaction usually happens after a few cycles because the toxicity builds up"
Me: blank stare followed with "what's a typical carboplatim reaction?"
Nurse: "Wheezing, flushing, tachycardia"
Me: "What do you normally do for it?"
Nurse: "Steroids and benadryl."
Me: "Sounds good."
Nurse: "Done"
Me: "ok"

Another nurse walks up to me and asked if I can talk to Dr. G on the phone (the attending for this patient). He tells me to stop the chemo, give him benadryl and steroids and send him home once he feels better.

Me to Nurse: "Well, let me know if he gets worse or doesn't get better"
Let me note that the patient was doing MUCH better by this point
Nurse: "Ok doctor, thanks for your help."

Help? Clearly this nurse was smoking crack.

Me: "You realize I am brand new and I don't know ANYTHING. Please feel free to teach me, correct me, and tell me what you think. I promise I won't get offended."
Nurse: "Cool"

All I have to say is thank God I was there. Man, what would nurse Bill have done without me?

What did I do next? Read about carboplatin!


K J and the kids said...

Gives me all the confidence in the world visiting the hospital now :)

For real though.....VERY SCARY !!
Trial by fire girl. You are going to do FANTASTIC. Think how much you will have learned after only one week.

Good luck with the next call/page :) and as my daughter recommends....take a deep breath and relax.

tallgirl said...

That is awesome. That nurse rocks.

When I was starting out, I learned more from my technician than I did from the other engineers. Even better, by listening to them I formed a good relationship with them so they did what I wanted before they did work for the other engineers. AND, they talked me up to the people which, of course, got back the board and eventually my boss.

Jen said...

Thank goodness for the nurses! Of course, I am partial to nurses. Especially murses.

Mary E said...

Your too funny!

BTW I was the unit coordinator in the chemo clinc at NWH for a while, just a little over a year ago. you could have called me...I would have known what to do hehehe....

rae said...

its always great to get a new med onc fellow. its funny to watch the staff oncs torture the fellows during rounds. *wink* i have to say i'd rather work with fellows than staff mds though, they are much more pleasant. they say that when a patient has an allergic reaction to carboplatin that they find the response rates tend to be higher in their tumor. and most of the time the patients can't be reinfused with carbo again. but there are studies out there (protocols) that are detoxing the body to make it able to receive platinum agents again. not very common though. aren't oncology nurses awesome??? they've seen just about everything!
good luck!!

amy said...

great nurse! and actually nice reaction on your part. a lot of doctors would have been too egotistical to admit that the nurse made the right call and that maybe they didn't know as much about a certain situation as the nurse did. one of my best friends is just the kind of doctor that i am referring to and so is her husband. they are both amazing people but when she tells me stories they irritate the heck out of me because of how condescending she is about the nurses. you are a breath of fresh air...

Holcomb.pittman said...

I laughed out loud. I CANNOT imagine the stress of something so new. You're gonna rock as an MD!