A Day and Night on Call
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.
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.