So my first 24 hour call went fine, or as fine as could be expected. Had a nice quiet day, with no admission to the unit up until about 8pm. And then over the next 8 hours, had four in total, all pretty sick, but none teetering on the precipice. I actually managed to get three hours of sleep to boot. The only real tough spot came at about 5am. There was a gentleman who had come in about 20 hours earlier with SOB, and had been doing fine on CPAP all day and night. But now he was looking like he was working pretty hard to breathe. He was satting 100% on 40%fio2, but breathing in the high 30’s. The intern called me in a mild panic, and waking me up from sleep to relay all this. I went to go see the guy, look him over, all the while with the intern whispering in my ear to tube him. To be fair, on the signout sheet, there was a little check box for “Intubate if pt deteriorates”, which certainly lended weight to the intern’s request. However, the guy’s exam was pretty normal, no crackles, no wheezes, only diffuse poor air movement. Looking back at it, the one thing I am most happy about, is that I didn’t feel completely brain dead despite waking up at 5am after 3 hours of sleep. Maybe it was reflex, maybe I actually had a decent thought or two, but I was pleased with the fact that I was able to keep calm and doctor on, as they say. Rather than jump to tubing the guy, I got an ABG, which was normal, cranked up his FiO2 to 100%, gave him a slug of Lasix and got a chest x-ray, remembering that he had some pulmonary edema earlier when he first came in. Twenty minutes later the guy was breathing around 20 and looked much more comfortable. When I came back the next day, the guy had been discharged home, so I’m guess I made the right decision. I don’t think tubing would have been a wrong decision either, just for the record. But yeah, so far so good.