A day at the Poison Center

My job as a medical student doing a Toxicology rotation at the Oregon Poison Center is to follow up on patients who are admitted to the hospital for tox-related issues. Most of these patients, unfortunately, have attempted suicide by overdosing on varying combinations of medications, both prescription and over-the-counter. And the particular combination or amount that they happened to chose was not immediately conducive to death, hence their admission to the intensive care unit instead of the morgue.

I arrive in the morning and get a list of the hospitalized patients that are scattered across the Poison Center's coverage area, which includes Oregon, Alaska, Nevada (except for Las Vegas), and Guam. An unlikely geographic collection, to be sure. You should see the timezone clocks hanging in the call center. After divying up the list between the other student and resident, I start making long distance phone calls, putting on my official Poison Center voice and asking the hospital operator to transfer me to the appropriate area of the hospital. Once transferred, I ask to speak to the patient's nurse, and then usually listen to smooth jazz versions of beatles songs for between 1 to 10 minutes. Once I have the nurse on the phone, I introduce myself again in my professional yet conversational, friendly yet no-nonsense, official medical voice with my pattened, well-rehersed tag line: "Hi [RN's name], this is Fiona with the Oregon/Alaska/Washoe (NV) Poison Center (no calls from Guam yet, unfortunately). I'm calling to follow up on patient Toxy McPosions. How is she doing today?" I then collect the appropriate information about status, vitals, EKG changes, and any relevant labs, in addition to the therapeutic interventions that the patient has received to date.

Once the hospital operator accidentally transferred me directly to the patient's room. "Hello?" said a gravely, sleep-drenched male voice. "Uhhh..." I said as my mind reeled in confusion and panic - this is not what is supposed to happen!! "Is this Mr. Johnson?" "Yeah." Oh my god. What do I say. What do you say to the person who is recovering from their unsuccessful suicidal overdose? "How are you feeling?" "Fine." .... pause... "I'm calling from the Poison Center... to check up on... on how you are doing." I can't believe these words are coming out of my mouth - this is awful. "I'm doing fine." "Great. Is your nurse available?" Very slick exit - the patient then presumably attempted to summon his own nurse, who I spoke with minutes later when I called back and asked to be transferred to the NURSE'S STATION. The nurse, of course, is much better equipped to give me a summary of the trend in liver function tests than the poor patient.

At rounds everyday we sit in the conference room and discuss each patient with the attending toxicologist. This is known as "rounding." At these sessions, decisions are made about starting treatment, stopping treatment, what other labs need to be ordered. This is also the appropriate time for testing the med student's knowledge of the stages of aspirin overdose, the symptoms of Neuroleptic Malignant Syndrome, or the one kind of toxic alcohol that does NOT cause an anion gap metabolic acidosis (its isopropol). This is known as "pimping." I then call the hospital back with the official Recommendations.

The whole process is quite interesting. Its odd, when you think about it, to be having long conversations about how to keep alive someone 2,000 miles away who was unsuccessful in their attempt to kill themselves. Its crazy. I suppose I simply can't imagine what it would be feel to actually come to the conclusion that ending your life is the only feasible option. This is inconcievable to me, and it makes me very sad that other people fight such deep horrible depression.

Interestingly, a very common intentional ingestion is acetaminophen (Tylenol), mostly because I don't think people know how bad death from liver failure actually is. Take it from me - its bad. Maybe I'm wrong, but I think people generally know that overdosing on tylenol can kill you. Atleast, the people who attempt suicide by taking a whole bottle are probably aware of this. But perhaps they think you will just go to sleep and never wake up, insead of gradually developing intractable abdominal pain and vomiting as your liver becomes inflamed to the point of complete dysfunction, eventually leading to acidosis, bleeding, and gradual decline in mental function as ammonia builds up and your brain swells within the skull. This is assuming that you are not a candidate for a liver transplant.

Anyway, I am enjoying my rotation so far. And blogging about it is providing excellent procrastination material.