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24 Hours On Call

MON 9:52PM One of the team's patients has cystic fibrosis (CF). Ryder explains that CF patients "have very tenuous lung status, so [we] try and isolate them as much as possible." Staff follow rigorous CF infection-control guidelines to avoid spreading germs among patients, since the respiratory secretions of CF patients can contain drug-resistant pathogens. For example, caregivers always wear a surgical gown—like the one Ryder has on here—when they go into a CF patient's room. DHMC houses the New Hampshire Cystic Fibrosis Center, which is accredited by the Cystic Fibrosis Foundation. At DHMC's center, a multidisciplinary team of physicians, nurses, physical therapists, respiratory therapists, nutritionists, social workers, and psychologists provide comprehensive care for CF patients and their families.

MON 10:03PM Ryder has stopped in a hallway to comfort the patient who is being transferred to her unit from the PACU. "I wanted this patient to stay in ICU [intensive care unit]-level care," says Ryder. However, there are no ICU beds available right at the moment.

MON 10:25PM Ryder is reading an electrocardiogram for the patient from the PACU while she's talking on the phone with the hospital official who is tonight's designated administrative coordinator on site (ACOS). The ACOS, a nurse supervisor who sees that the hospital runs smoothly after hours, must authorize any nighttime patient transfers. Ryder is still trying to see when she can get the PACU patient into an ICU. A few hours later, she is able to have him moved to the Coronary Care Unit, an ICU for cardiac patients.

MON 11:52PM Fellow resident Martin Palmeri, who's also on call tonight, accompanies Ryder to the Medical Center's latenight deli. "There's always this debate around midnight," explains Ryder. "Do you get the caffeine? . . . Or do you stick it out [and] try not to get the caffeine in the hopes that you'll get to bed soon? I usually end up getting the caffeine."

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