My last night on call was a week ago and it was a night filled with laughter and friends, some excitement and anxiety over patients, lots of smiles, and lots of yawns.

I told you about my lovely birthday breakfast, and then I went right to sleep for my mid-morning/afternoon nap.  After I woke up, I did a longer than usual run on my treadmill.  I’m normally a 3-4 mile and call it quits kind of runner, but with Dancing With The Stars on my iPad, I just kept going!

I had gotten a few pages from a nurse about one of my patients.  Their oxygen saturation was low which means they weren’t getting enough oxygen into their lungs.   This patient does this at night sometimes, and if you wake them up, they usually bring their oxygen levels up pretty quickly.  But this night, nothing was changing the oxygen saturation.  I would have been happy with sats between 88-92%, but this patient was hanging out around 82% with 5 liters of oxygen on through nasal cannula.

That’s bad.

So, I came down to the room to listen to this patient’s lungs.  I heard wheezes in the upper lung fields, so I figured a nebulizer treatment might help them breath better.  Well… here’s where things got interesting.

This patient doesn’t speak English.  They have been in the hospital for over a month, so I know this person well, but there is still a big language barrier.  Every morning, I call for an interpreter, but at 4 am, you can’t find an interpreter very easily.

The patient often doesn’t understand what’s going on, and tends to get frustrated.  When they get frustrated, they start to refuse treatments.  So, of course- without an interpreter, this patient started to get mad at all the commotion in their room without explanation, and so they refused the oxygen mask and the nebulizer treatment.

As they started refusing treatment, the oxygen started hovering closer to 79-80%… that’s bad.

The nurse had already paged an interpreter several times, but they wouldn’t be coming for close to an hour.  I had tried to use our iPad interpreters, but the connection was bad and kept cutting out.  Also, the online or phone interpreters just don’t understand this patient (who can be kind of difficult) and so it’s really better to have someone there in person.

So basically I was freaking out.  This patient was hypoxic and I didn’t know how long they would last with oxygen that low.  The nurses wanted to call an RRT which is the Mayo term for a Rapid Response and generally happens when someone needs to go to the ICU.  I was worried that all the chaos of an RRT would just make this patient MORE mad, which would make them refuse MORE treatment.

Ahhhhhh!!!!!  What to do!?  One of our medical students actually happens to speak the language of this patient, and had been seeing the patient every day. So, at 4 am I started frantically paging the medical student.

“Hi it’s Andrea. Patient X is refusing oxygen and their sats are in the 70s-80s.  X doesn’t understand and we can’t get an interpreter!  Please call me!!!!”

After a few minutes of frantic paging with no success, the nurse decided to go ahead and call an RRT.  Within minutes the ICU fellow arrived along with lots of other nurses and respiratory therapists.  I used the phone interpreter to tell the patient, “this is an emergency and you need to go to the ICU.  We will explain with the interpreter in the morning, but you need to trust me.”  I had already had long discussions with the patient about what kinds of treatment they wanted in an emergency and I knew they wanted us to do everything we could… so, that’s what I did.

Luckily, the patient finally agreed and was sent up to the ICU for more intense respiratory support.  They actually did really well and have now transferred back to our service.  Phew!!

And that was my night on call!