Showing posts with label on call. Show all posts
Showing posts with label on call. Show all posts

Tuesday, May 26, 2015

My Life as a Call Girl

I spend 1/4 of my life on call. With 10 years of private practice in OB/GYN under my belt that's 2.5 years that I've been tied to my phone. Some nights I sleep peacefully through the night, but more often than not, I get to trek in at 3 am to catch a baby or two. Over the years, I've come up with my own set of on call rules to help navigate the chaos that can be a call night.


Don't dread it. Obviously, I don't wake up on my call day with a spring in my step, open the windows and shout for joy for all to hear "Yeah, I get to be on call today!" But I don't dread it either. I've learned to deal with it and enjoy it the best I can. If I didn't make peace with being on call then, I end up wishing away a quarter of my life.

Don't complain about it. When I chose OB/GYN I chose a crazy, sleep deprived life. Sometimes when I'm working postcall I will "explain" to people why I look hot mess of disheveled craziness (ie I delivered 17 babies last night). I try to keep it in a upbeat joking tone and not a "Woe is me! I work all the time" tone. We all know those providers who claim that every single call is the"Worst call ever" and that is simply annoying.

Don't indulge in the 3 am donuts. When you are up all night, the 3 am donuts can look so very tempting. Sometimes I delude myself into thinking "I deserve a treat" for having to work all night, however my 40 year old metabolism does not agree and I regret it later. I always keep healthier snacks like almonds and trail mix with me for just such emergencies.

Don't schedule appointments. After getting called in half way through a haircut once, I learned this lesson the hard way.

Don't socialize. If my leaving the event will be awkward, I won't schedule it when I'm on call; like dinner with just one other couple. If it's a bigger group of friends, I will sometimes try to go if I can. Also having people over is definitely out as well. Having to rush out half way through cooking dinner is not a great plan.


Do live your life. I can't put my life on hold completely when I'm on call. I still go to soccer games and church, I just drive separately in case I get called in. I still exercise, I just make sure when I'm running I have my phone on me and am always less than 10 min from my house. Sure this means that occasionally I have to race into the hospital all sweaty and get amniotic fluid on my Lulu tights but there are enough excuses not to exercise and I won't let call be one of them.

Do keep some entertainment close by. A lot of call can be "hurry up and wait." I often spend time waiting for an OR to open up or waiting for patient to deliver. I use this time for catch up charting and CME and reading.  This is actually my one bit of call superstition: I always keep a novel with me in hopes I won't need it.

Do Bathe. My biggest pet peeve is getting called to the hospital stat when I'm in the middle of a shower. Yes, the ruptured ectopic pregnancy is far more important than me having a bad hair day, but still it's annoying. I wish I could get away with not bathing on call but that would not be socially acceptable. Instead, I keep extra toiletries handy to throw in bag a the last minute as needed to get ready at the hospital.

Do know your limits. I am human. Occasionally, I need to ask for help. If a call is particularly awful I will get one my NPs to field phone calls. There are times I've cancelled part of my afternoon postcall to go home and rest. So no, I don't complain about every single call, but when I'm dangerously tired I listen to my body and rest.

So there are my call survival tips. I'd love to hear from the other MIMs on how they maintain sanity while juggling their pagers.

Saturday, September 20, 2014

Birthday Call: from zero to 60 and then somewhere in the middle in mere hours

40 minutes into my commute to work, I had a pseudo-melt down. As I sang “Happy Birthday” over the phone to my three-year-old, I lost it. I realized that I hadn’t kissed him on his birthday, I’d forgotten my lunch and during a 28 hour call the cafeteria food begins to make me nauseous, and that I was exceedingly anxious about all of the changes our lives will encounter over the next few months.

Needless to say, I’m in the call room after a deluge of discharges, awaiting our next transfer, feeling the urge to write and release this tension.

My Little Zo is three today. Three years ago, on this day, I birthed a fabulous little human being into the world. He’s helped me grow in countless ways. I’ve learned to let go. I’ve learned to give my all in the moment and then pass things off to someone else (to hubby O, to my parents/in-laws, to the wonderful ladies at daycare, to his Pediatrician). I’ve learned that keeping your own kid alive and occupied means breaking lots of rules (my infant slept on his belly after weeks of sleepless nights, my 2 year old ate yogurt and spinach smoothies or oatmeal for dinner on picky-eating nights) and that I am so much more capable than I ever thought imaginable. I’ve realized what’s important (playing legos and dinosaurs before bedtime and leaving my notes until he’s gone to bed, sleep, couple time, giving my all at work and not worrying about my child since he’s taken care of at all times).

In less than a year, I’ll be an Attending and yet another goal will have been achieved. I have had a few successful telephone interviews and I have my first in-person interview in October with a community health system affiliated with my medical school. This morning when I was sobbing, a great friend, KJ, who is now a Pediatrician in private practice gave me her pep-talk. We have these at least once every few months. She tells me about all of the little and big victories she has in her life after residency. She has weekends off and time to be with her boyfriend and her dog. She tells me about her quirky colleagues and her amazing patients. She tells me how different things will be in a few short months.

So, on Little Zo’s third birthday, I went from zero (dragging myself out of bed after an exhausting month on inpatient service during asthma season), to 60 (sobbing in the Starbucks parking lot), to somewhere in the middle. I am thankful for three years of motherhood. Thankful that Zo is vibrant, healthy, active, super-smart, and super-sweet (when he’s not biting or hitting). Thankful for only 3 more days on inpatient service before 2 months of elective and that I've been able to do great work this month and keep folks' babies alive and healthy! Thankful for friends like KJ who understand the struggles of residency-based medical practice. Sad that I wasn’t at home snuggling Zo and our visiting family members. And hopeful of life after residency.

Happy birthday to my little roaring dinosaur - Mommy loves you!

Monday, March 31, 2014

Keeping it moving on an overnight call

5 admissions, 4 discharges, PICU transfer. That sums up my night.

I could dwell on the negatives (exhaustion, cold under-heated hallways with headache-inducing fluorescent lights) or I can focus on the positives.

The positives. We managed the craziness with style and grace. No one died. Though one Nurse did come down with something and ended up in the Emergency Department. We (Interns and I) learned many things about patient care and prioritizing. I learned that even though my eyes are burning and my reaction time has slowed down considerably, I know enough to keep patients alive, manage a variety of conditions pretty darn well, and even alleviate some parental anxiety. I can successfully perform a lumbar puncture even after the Intern is unsuccessful and I have to bust through the big ole’ hematoma he left behind. Bammm how do you like all those red blood cells?!? What lab representative, red blood cells aren’t good?!? Of course I know that but at least I have enough cerebrospinal fluid for a gram stain and culture. Could you run those STAT please?!? I can scrounge up a makeshift meal (cereal, graham crackers, peanut butter, diet Coca Cola) to avoid my own hypoglycemia in spite of the fact that due to budget-cuts the cafeteria now closes at 8pm. I can snuggle sick babies and help position them so that they don’t become hypoxemic at 2:30am. I can make my exhausted Intern laugh at our horrible night. I can make my Nurses feel appreciated and not hate me even though they are ready to label me a “Black Cloud”.

And just to cap the whole night off, after a particularly crazy admission where we were all unknowingly exposed to some infectious respiratory goobers, we exited the room quickly, donned our masks and proceeded to do a modified line-dance down the hallway back into the room where we provided judgement-free exemplary service.

At this point, I just want to curl up in the call room, but there are far too many labs to follow up on and kiddos to check up on.

So to those out there in call-land, keep it moving and keep those patients alive! Cuz’ you know I will :-)

Tuesday, August 2, 2011

Not just us anymore

I had planned to write about my first post baby overnight call which occurred a couple of weeks ago. Long story short, I survived, hubby survived and my little peanut survived. I felt good to be back in the hospital and thankfully it really was like riding a bike, everything came back to me (FYI - I actually can’t ride a bike, but that’s another story). I may still write about it later, because I did gain some nice insights, however, now as I get ready for my next overnight call and a potential procurement call, I decided to write about this new feeling of accountability.

I have one more year left in the lab and I just started taking overnight ICU call twice a month in order to keep my feet wet. Last week I was asked if I would like to to cover some organ procurement calls as well. Initially, I wanted to jump at the opportunity (I’m interested in transplant surgery). However, when thinking about the burden middle of the night procurement puts on my hubby (especially with one car), I decided to table it unless they were really in a bind. Then, I kept thinking about it. And suddenly I was paralyzed about the thought of getting on a random, unregulated jet in the middle of the night with a baby at home. I’ve flown on a number of procurements in the past and I love riding in the jet. I love the free meal we get on the ride over, the much needed nap on the way home, and the urgency of getting organs back to help save someone who has been desperately waiting for them. However, now all I could think of was the danger of these jet journeys. What if I crashed? How could I be so frivolous with my life and safety? Even while on call, I find myself being a LOT more diligent about wearing my PPE and more being careful when putting in lines. A fellow resident is currently suffering on antiretrovirals after being stuck with an open bore needle of an HIV patient - one of my biggest fears. Now, these fears which were sort of trivial, in the background, part of the job fears have moved promptly to the forefront of my mind. I now feel as if I’m not just taking risks for me and my grown adult husband. Now the risks affect my innocent child.

I don’t really know how to deal with this new feeling of accountability. Specific to the risks of being a transplant surgeon (flying and Hep C) I plan to follow one of my husband's suggestions of finding Pauline Chen and asking her! (Yes, he, the non-medical one, knew about Pauline Chen!) I enjoy my work and I fully understood that there were some occupational hazards when I signed up. However, in the meantime, I wonder how others feel about the things we expose ourselves to at work and how that affects our children.

Sunday, March 27, 2011

Pager Anxiety*

I was on call for 7 days starting last Friday. My mother watched Babyboy all day until I got home from work close to 7 pm. My husband was traveling. Mom and I had a bowl of soup together, and then she went home. I was thankful knowing she would be on duty for me Saturday and Sunday so I could go in and round on my patients. Babyboy and I set about our usual Friday night routine: he sat on my bed supported by pillows as I got my pajamas on; then we did tummy-time for a bit and sang songs for a bit. As soon as he started to rub his eyes, I darkened his lights, set Sleep Sheep on “rainfall”, and gave him a warm milkie bottle. And as per usual, he conked out.
Time for Mommy to conk out. I set my pager on the bedside table, turned out the light, and nestled down for the night. Then, “Bip!” the pager went off. I startled and turned the lights back on and fussed with my glasses and looked at the page text: an urgent page from someone with a sore throat. Sigh. I got up, logged into the computer, pulled up the patient’s chart and called her. A young new mom, her baby is in daycare and is on his 3rd course of antibiotics for an ear infection. Now she’s had a very sore throat and fever over 101 and difficulty swallowing. She knows she should have come into the office, but between work and the baby, she couldn’t. She’s miserable, she’s pretty sure this is Strep, can I help her? Sure. We chatted, she was very gracious, and I felt good to be able to help her out. I called in her Amoxicillin and that was that.
I again set the pager down on the bedside table, turned out the light, and settled down to try to sleep. But how could I sleep when I kept worrying and fretting that the pager would go off again?
Sigh. This has been an ongoing issue since residency. As a resident, when you’re on call, you’re in the hospital, often covering more than one service. As an example, when I was on Pediatrics call, I sometimes would cover two floors: toddler and school age. Back then, each floor had their own pager. Then there was the clinic pager. This in addition to my own personal pager. So it was not abnormal to be wearing 4 pagers. I had to double-knot my scrub bottoms so they stayed up with all these pagers clipped to my waist. It was a feat to use the bathroom and not lose one down the toilet!
And they beeped. A lot. I remember being on call one overnight at a satellite hospital. I was the resident covering the Peds ward, admissions, and backup for labor and delivery. I was paired with an intern who was thankfully a smart and cool-headed guy. For most of the night, we were working with a newly admitted teenager in diabetic ketoacidosis. The teen was on an insulin drip, and their blood sugars, electrolytes and acid/base balance had to be watched carefully. We were being paged so often about the teen that we decided to just stay up there. But, BEEP! A code in the ER! An 8 year old in status epilepticus. We ran and got there at the same time as the on-call anesthesiologist. We decided to sedate and intubate the boy, give as much Valium and other antiepileptics as we could and call for transport to the Main hospital. Then, BEEP! we were STAT paged to a delivery. The resident covering Neonatal was already in a delivery, and there was another imminent delivery that required Peds presence: premature TWINS. They were 32 weeks, which is little but not too too little. They would need to be in the NICU (Neonatal intensive care) for a few weeks, but they were fine. The whole time there were numerous other pages: issues with the admitted children on the ward, beep beep beep; some new admissions to go and see, beep beep. We split up to try to cover it all.
That was a pretty bad night on pediatrics, but it wasn’t abnormal. Medicine codes were much more common, and arguably worse, because people died more often. The medicine code pager, which went off if there was an adult in cardiac or respiratory arrest somewhere in the hospital, had the loudest, most obnoxious sound: “REE-OO-REE-OO-REEEEE”. If I’m in my hospital now, and someone’s pager is set to that tone, I get so uncomfortable. I want to run, or hit them.
I now have my pager set to a sound that isn’t at all like the ones I had in residency. It’s a little “Bip!”, almost a chirp, really. And it never means I have to run anywhere. I only need to be able to pick up the phone and talk, and think. But when that thing goes off, I might as well be back on the floors again. I’m like a returned soldier from ‘Nam, man. Just a tad PTSD.
There was even one holiday weekend, a Fourth of July, where my office was closed on a Friday. I was on call starting that morning. It was a beautiful day, sunny and warm. But the pager went off every five minutes for the whole day. I was planted at my desk, fielding calls, reading charts, looking up answers, trying to keep track of all the issues. The calls piled up. People were annoyed that the office was closed, and that I took so long to get back to them. I went into a full-fledged panic attack at one point. I can now tell my patients with panic attacks that I really do know what a panic attack feels like.
And so, a week ago Friday, there I was, in bed and trying to sleep, in the safety and comfort of my own bedroom, and I couldn’t sleep, after just one benign page. I even started drifting off to sleep, and hallucinated that the pager beeped. I woke up and turned the lights on and stared, but there was no blinking callback number, no message.
I finally fell asleep. Then, at 4:30 a.m., “Bip!” From the deepest sleep, I startled, turned the light on, fumbled with my glasses, and looked at the message. An urgent call for nausea, vomiting. I sighed, pulled myself up and to the computer, and dialed. The lady had school-aged children. She couldn’t keep anything down. I talked to her husband. We agreed that he would take her into the emergency room. I called the emergency room to let them know she was on her way and that I suspected Norovirus, that she would likely need IV fluids. I typed a brief note. I went back to bed.
Two hours later, I was still awake.
*originally posted at March 19, 2011

Monday, August 25, 2008

Tucked in

As a resident running the family practice ward, I would come up to the unit in the evening to finish dictations and complete paperwork. At the end of the evening, I'd ask the nurse if there were any patients she was concerned about or orders she wanted written. Having tied up all the loose ends, I'd head to the call room.
I distinctly remember how I felt walking down the corridor at eleven at night. The ward was hushed and still, with the patients' lights off and just one or two staff at the nursing station. Heading back to the elevator, past rooms of four beds apiece with patients curled up under blue cotton blankets, I felt maternal. Or how I imagined maternal would feel, as I hadn't had a child yet.
It was a powerful emotion, a combination of affection and respect for my charges, the satisfaction of having managed the day's problems, the weight of responsibility, and humility and gratefulness for my own position.
These days, as I round on my own children every night before bed, the flood of feeling as I adjust the covers over small sleeping bodies is remarkably similar.
And I realize now that those late nights walking down the corridor of 7B, the sense was of having tucked the kids in for the night.