Trust no one, especially not your half-sleepy self!

Tip #5: Always have a backup alarm

Whether that’s having two alarm clocks or setting multiple alarms, always have a fail-proof. I personally use 3 different alarms. One is my radio-clock which I let run in the background to wake me up. I then have an alarm on my phone that I set to when I want to wake up. It’s usually several minutes after the first.

Then I have a second alarm set at the latest possible time as a backup, in case my previous two alarms have failed me. I cross cover with my phone and a traditional alarm, so even with powerouts or if I forget to plug my phone in or it’s on vibrate, I will wake up.

Of course, this often backfires and I forget to turn off all my alarms when I want to sleep in on a weekend.

Please Note: The following post is a dramaticized version of being on call. The views expressed is that of a post-call sleep deprived individual. It in no way reflects the normal views of a well-rested and well-fed person.

http://www.flickr.com/photos/b-love/2621896117/#/

8:00 – It’s the beginning of a weekend call shift. I feel a bit more refreshed than normal, having slept an additional hour since weekend handovers start later. I quickly print off a new list of patients and pre-round on my own patients. Who knows what will happen this call shift

11:30 (Page #1) – The first page of the day from Ward A. It’s to clarify an order written by another team member. The last two hours has been pretty efficient. Our team had just rounded on the new admissions. All the necessary consults and tests for the day had been arranged. The resident on call last night just went home and I am pretty much on my own from here on. 25 Patients. Hopefully no one crashes today.

12:15 (Page #2) – I’m playing phone tag with the laboratory. I’m trying to get a lab result that is pending. Hmmm.. no luck.

13:17 (Page #3) – Mrs. X’s family is visiting and they want to speak to someone about the test results. Mrs. X isn’t one of my patients though, I explain to the charge nurse. I’m more than willing to look over their chart and discuss whatever is written down, b)ut I think it would be much better if they left some contact information and when the doctor looking after her is in, we can give them a call.

Phew. Fended off an awkward encounter where I would be reading off progress notes to a family about a patient I didn’t know.

13:23 (Page #4) – We’re unwrapping Ms. B’s wound dressings, would you like to take a look? I swing by quickly to take a peek and see that they are healing well. I thank the nurses for letting me know.

Things seem pretty quiet right now. Time to grab lunch and finish off some leftover dictations.

14:21 (Page #5) – I had just finished my first dictation when Ward A (it’s always Ward A) calls me to let me know that I need to come pull out a pigtail drain. I tell them I’ll be there in an hour or so if they don’t mind, I just have one more dictation to finish.

15:41 (Page #6) – It’s Ward B. The lab results are in from this morning and several patients have low Hg. “Can you come take a look at these lab values?” I browse through multiple charts. Hmmm, we can re-order blood work for this gentleman tomorrow. For her, her Hg has been chronically low.

When the nurses do their shift changes, the chances of you getting paged reaches 100%.

15:54 (Page #7) – Another family wants to talk about what we plan to do next for the patient. Again, a colleague of mine is taking care of them. I make the offer that I can explain what is going on to the best of my abilities, but it would be best to ask when our whole team is here, you might get a better picture. They are quite understanding and thank me anyways.

16:25 (Page #8) – Ward A again. Mrs. C just had explosive diarrhea all over the floor. Shit. Mrs. T was one of our sicker patients and it was only a few days ago that death seemed to be inevitable. She subsequently recovered and was doing well until now. My next half hour is spent making sure she was ok, ordering the necessary tests and precautions. Just when I finish I get paged…

16:52 (Page #9) – Mrs. S isn’t breathing so well. Her O2 sats are going down. I rush over to her bedside and notice that she does seem more tired than usual. However, her O2 sats look pretty good. I wean down her oxygen and they are still pretty good. She has a long history of COPD, there’s no need to give her so much oxygen.

For some reason, people always jack up the oxygen. I adjust it back down and make a note to come check on her later.

17:28 (Page #10) - It’s the ER. There’s a patient for you to see here. The first admission of the day. I wrap up my ward work and head downstairs.

17:32 (Page #11) – I was paged on my way down to the ER. It’s Ward A again. They let me know that they need a coumadin order for tonight. Easy fix.

20:17 (Page #12) – It’s been pretty good for the last 2 hours. I had finished my admission and I wasn’t interrupted for a whole 2 hours. “Mrs.C (the lady with the diarrhea) is having troubles breathing, can you come take a look?” Here we go again…

23:37 (Page #13) – Things have been pretty stable around the wards. I was getting paged about Mrs. C and her breathing again. Alright, time to give her some Lasix…

02:12 (Page #14) – I had just finished rounding on the wards after midnight and was just about to head for the call room when I got paged. Mr. P is having trouble sleeping, can you give him something to sleep?

I’m thinking, I’m having troubles sleeping too, I wish I could take something to help me sleep too.

I quickly take the chance to catch some sleep, knowing that the likelihood of getting awoken was pretty high.

03:30 (Page #15) – It’s the senior resident, we have a patient for you to see in the ER. Why? WHY? Why are people always admitted in the middle of the night.

03:31 (Page #16) – No more than a minute later after the last page, it’s Ward A. Mrs. S doesn’t look good, I think we may need to call ICU. “I’ll be there immediately”

In moments like this, when you’re sleep deprived and overworked, you almost wish the little old lady would die already so you could get some rest. But, I pushed those thoughts out of my head and knew that was just my half-awaken mind speaking.

I called up the junior and senior resident and we ended up consulting ICU, reordering blood work and imaging. The patient wasn’t as sick as the nurses portrayed her to be, but she was still pretty sick. But she stabilized and I eventually got to finish my admission in the ER.

06:00 - I finally wrapped things up on the ward. I ran to my call room lest I be called to do more scutwork. The moment my head hit the pillow…

08:00 – Time for morning rounds and teaching. Nonetheless, I wasn’t too energetic or focused during the session.

08:05 (Page #17) – I’m getting paged during our teaching session… I look at my pager in disgust, this electronic leash that has caused me so much grief. They’re paging me about insulin orders for a patient that is not mine. Ughh…

08:09 (Page #18) – Ok, this is getting ridiculous…

09:30 – I eventually present the two admissions to my team. My presentation was sloppy though partly because I did not have my notes in front of me, so most of it was done by memory, and two, I was pretty tired.

I also felt quite sick. This headache and nausea was bothering me.

I take my pulse, 120bpm. I’m pretty sure I am running a fever, and if they drew some blood, I’m almost certain by WBC would be elevated from the lack of sleep and stress. I was felt sicker than some of the patients on the ward.

11:30 – After rounding and wrapping up loose ends, I finally make it home.

Out of the three basic human necessities, I opt for the one that often gets ignored. I decide to take a crap. I realize I hadn’t taken a dump in the last 24 hours.

11:45 – The feeling of sleeping in my own bed is so good. However, I start to feel feverish and my muscles are acheing.

I’m pretty sure I caught something, most likely a virus, during my call shift.

Life is pretty crappy right now.

I can’t believe I’m on call again in 2 days.

There is lots of medicine to learn on the wards. You’re always busy taking histories, making assessments, writing notes and writing orders for a treatment plan. There are times when you get stuck with scutwork, more often than not paperwork that needs to be filled or things no one else wants to do.

http://www.flickr.com/photos/stephangeyer/3906454739/

In my case, I’m stuck with a patient.

She’s a homeless lady that bounces in and out of all the hospitals. She has chronic addiction problems and  she has been evicted from every possible halfway house, detox program, government assistance, low-income rent in the city due to her continual drinking habits. No one is willing to take her. Her family members are not willing to take care of her and they are refusing to look after her in any of their homes. Most homeless people we can send to a shelter. Yet anytime we suggest sending her to a one of the many shelters in the city, leads to a barrage of phone calls and verbal abuse from family members. They accuse us of killing her and that there will be blood on our hands if we send her outside during the winter.

This patient has poor health but does not have any acute or ongoing medical issues. Her problems are social issues and specifically her drinking problems.

And as a MS3, I’ve spent several hours over the last two days trying to find a solution for her. Each day she stays in the hospital is costing taxpayer’s a few thousand dollars. Each day she’s in here, is another day this bed is occupied and not in use for someone with current medical issues requiring hospitalization. This is a no-win situation. The social worker is frustrated. Our medical team feels she has no reason to be in a hospital. The patient is lying to the nurses, social workers and other health care workers in order to buy a few more days in hospital.

Being in the medical profession can be quite frustrating when you’re stuck with difficult “social” cases. And as a medical student, when you have to take time – out of the little you have – to deal with disposition issues, you can become quite frustated. That is time that could be better spent seeing your other patients, learning at the bedside or catching up on your reading. Instead, you are stuck with bureacracy of paperwork and phone calls.

It’s things like this can drain the energy from your day and depress your mood when you get home.

I think the plan is to discharge her tomorrow (she’s already delayed it by 2 days) back to her family whether they like it or not. Now… the only question is how long will it be before she bounces back. It’s stuff like this that makes me dread going in some mornings.

*Events and identities changed to protect patient confidentiality.

As you can tell, I often struggle with getting up in the morning to preround.

Tip #4: Have a evening and morning routine

A little bit of planning goes a long way for making your wake-up ritual a more pleasant one. If you’re a night owl like me, try to prepare all the things you’ll need to do in the morning before you sleep. For me that includes packing my bags, making lunch and having all my clothes laid out. All my important items such as keys, wallet, watch are all collected and in a visible place. Have a morning routine, whether that’s showering to wake you up or checking your emails. The more task oriented your morning is, the more motivation you have to wake up.

Even if you’re an early bird, you’ll find doing all the little errands before you sleep will make it less likely that you’ll forget something in the morning.

It also means you can catch a few more snoozes in the mornings since you won’t be as rushed. And if you ever oversleep (it will happen), you can just wake up, jump into your clothes, grab your stuff and run.

For those days where you wake up and have a hard time getting out of bed.

Tip #3: Turn on the Lights!

A common pitfall is to hit that snooze button once your alarm goes off and go back to bed. Instead, you should hit the on button for some light! Whether it be from a lamp, room light, or window, bright light will prevent you from falling back into a deep sleep and help wake you up.

When I’m on call and I know I may need to wake up to answer a page or see a patient, I keep a light on in the room. So if I do get awoken, I am not scrambling around in the dark trying to figure out where I am.

Have a light switch nearby. If there isn’t any, move your alarm clock next to one. That way you can turn on the lights and stay awake after you alarm has been turned off.

Since I have to wake up so often sleep deprived, I must have used every trick in the book to perk myself up.

Tip #2: Have someone call you, or wake someone else up.

Let’s admit it, most of us are lousy on being accountable to ourselves. We always forget to do what we said we would do. We procrastinate and avoid things if we can. However, if you are accountable to someone else, somehow we are more compelled to follow through.

So have a friend call you and remind you to wake up. Try it, you’ll find it harder to say no.

Better yet, if you are the one waking someone up, you feel more personal responsibility to get up yourself.

Chronic sleep deprivation, something that’s all too familiar as a medical student and resident.

The real solution to waking up easier is to get more sleep, but if that was the case you wouldn’t need tricks to help you awake.

Some people set multiple alarm clocks, staggered as fail-safes. Some hide their alarm clocks. However, I use one additional method that’s as old as it gets to help me wake up on mornings which are difficult.

Tip #1: Drink a glass of water before going to sleep

The urge of wanting to go pee will beat out the urge to go back to sleep… Once you’re up and in the washroom, the chances of you falling back to sleep are slim to none.