Evening Shift

Last night I worked my first evening shift as a staff pharmacist. Note to supervisor - do not schedule new staff pharmacist for first evening shift ever on Friday 13th! Holy shit - it was a nightmare. Let me preface this by saying that on evening shifts only one pharmacist is present in the entire hospital - no techs, no help. I felt like I was stranded on a desert island. Here's the night in summary - veteran admitted around 4:00 with shortness of breath - determined to have coagulopathy (also was on warfarin with supratherapeutic INR). This same vet was later diagnosed with diffuse alveolar hemorrhage and failed intubation twice. An anaesethesiologist had to intubate. This poor man kept me in the IV room and the ICU for 4 hours. I made the fentanyl drip and took it up to him. He was covered in blood. The ICU attending ran me back downstairs to make a stat norepinephrine drip. Meanwhile the man in the bed beside him had a critically low K and needed fluids, K runners, and K packets. Did I also mention that his propofol ran out as did his insulin drip??? Let me back up and explain fenantyl drips - to get fentanyl I have to go to the Outpatient Narcotic Vault to dispense it out and then carry it downstairs to the IV room and then compound the drip and then carry that upstairs to the fourth floor. So - fentanyl drips are kind of a big deal (not to mention that the fentanyl is in ampules!). Meanwhile, we had 3 admits to the acute care floor and I received 5 missing doses for various patients. Add to that a discharge from the acute floor. It was a bit hectic. So finally, around 9:30, after I got all the meds sent out, I figured things were slowing down. Yea - not even close. I got the call at 9:30 that the alveolar hemorrhage patient was dying and would die without recombinant factor VIIa (read - EXPENSIVE, RARE DRUG). I found two vials in our fridge - but the guy needed two vials per dose AND needed it every 2 hours until he stopped bleeding. And then the real fun began. I got him his first dose and then spent the next 2 hours searching for more. Oh and did I mention that the nurses refused to give it as it is not in their scope? Yea - the hits just kept coming. So I called the local hospital - none. I called Winchester - go fish. I called Washington County - go fish. I called Frederick - go fish. I called DC VAMC - go fish (after I spelled the Novoseven, told them the generic, and the use for the drug). I called Walter Reed - apparently their pharmacists go home at 4. I called Baltimore VAMC - SCORE. I got 4 vials - but then I couldn't get anyone to get it for me. I called the fire department told them this guy was dying now and needed the drug in 1 hour (Baltimore is 1.5 hours from here). Fire department basically told me that it wasn't their priority as they were short staffed. AOD informed me that the local taxi service would not drive to Baltimore. Finally a driver for the facility came in for OT to pick up the drug. I left at 12:30 - 30 minutes after my shift ended. I don't know when the Novoseven arrived - I don't know if the guy is still alive. I went home - put my feet up - drank 2 beers and went to bed. Holy shit - what a night. But - even when I was sweating my ass off and totally stressed out, I was thinking to myself - I LOVE THIS! :)