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?"
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."
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."
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!