Call. Oy.

My on-call night Thursday was particularly rough. For those wondering what it means to be on call, it means that you're covering your service (i.e. surgery) after regular hours into the next day until the full team gets back. Basically your work day extends through the night and into the next day. For me that meant in at 5AM Thursday and leaving at 11AM Friday...technically. Technically because there's supposedly a thirty hour workday rule. Much like there's an 80 hour work week rule. Both rules are more guidelines than anything. I actually left on time Friday. But my work weeks are at least 89 hours.

It's not *as* bad most nights, when I can get an hour or two of sleep. Thursday night was crazy busy though. Meaning me and the intern got no sleep. At times during morning rounds, I was pretty much a walking zombie. Before rounds, the intern fell asleep at the computer 3-4 times. Surprisingly though, I was good for the vast majority of the "day." The sleepiness only hit when things slowed down for a bit. The worst part was the hunger actually. My dinner was at 630P Thursday. I didn't eat a meal again until noon Friday. Fortunately, I'd learned to stuff my white coat with some granola bars. I went through about 8 bars that night/morning.

Before midnight it seemed like the pager was going off every 5 minutes. Some of the stuff was just nurses. Half of them were consults though. A consult is the worst type of page. Especially when only 2.5 people (chief resident, intern, med student) are covering four surgical services: thoracic, pediatric, general, and vascular surgery. A consult takes awhile because you have to do a quick read on the chart, look at vitals/labs/imaging, do a quick h&p with the patient, and then present to your senior(s). The whole process can take 30-45 minutes. And when consults start piling up, on top of regular nurse pages, postop checks, floor work, and whatnot - it gets a little overwhelming. There was a time when six consults had piled up between me and the intern. You just hope that no one gets missed or left behind. The best type of mistake is one where no one dies. In all seriousness. As interns or med students, we will mess up at some point. I'm constantly reminded by upper levels that it's all good as long as no one dies.

Quick side note about consults in the ER. Patients usually aren't too happy. By the time surgery gets a consult for an ER patient, they've already been there for 6+ hours. Abdominal pain, once ruled nonemergent, gets triaged lower on the ER's queue. Once they finally get seen by the ER, labs and imaging can take a while to get going. After all that, surgery finally gets consulted. No one likes talking to three members of the surgical team three separate times. On top of that, no one likes hearing they need surgery. It makes for interesting trips down to the ER.

As bad as things may sound, things aren't all that bad. The team's reduced to minimal numbers meaning there's a lot more for each of us to do. Spun in a good way, that means that I learn a lot more and get to do a lot more stuff when on call, vs during the day. While on call, we're also on page for the trauma service. Last Thursday there were about 15 trauma pages through the night. About 10 of those were gun shots/stabbings. Welcome to summer on Chicago's south side. On slower nights, I usually make my way down to the ER for trauma pages...since I'm interested in both trauma surgery and emergency medicine. And luckily, I'll actually get to rotate through trauma surgery for a week. It's supposed to be pretty cool and they supposedly let you do a lot of stuff...especially when on call. I already got to do a decent amount of stuff on my rotation through pediatric and thoracic surgery last week, so I'm pretty psyched.

Back to the sleep deprivation. It's real and thus has real effects. While pulling numbers on patients, basic things like reading efficiently become more difficult somehow. As long as I'm actively involved in something the next morning though, it's pretty easy to stay awake and perform similar to precall levels. It's even pretty easy to turn off the drowsiness and act wide awake while talking to patients. It's when things slow down the next morning that nodding off becomes an issue. On that note, driving is particularly problematic. Sitting is already a bad idea. Doing something boring, semi-passive, and monotonous is even worse. There were a few times when I almost fell asleep. And I did doze off a bit at a traffic light. Being on the phone definitely helps. But next time I have that rough a night, I'll probably take a nap in an on call room before heading home.

All that said, being on call is an interesting experience. Personalities change, things get crazy, and there's not a lot of sleep to be had. Since I'm on call tomorrow night, I think I'll get to bed early. It's a new strategy...getting plenty of sleep before going on call. Results TBA.

Last week's highlights:
-5 day old newborn with his stomach, intestines, and spleen herniating through the diaphragm into the left side of his chest and preventing development of that lung
-taking out someone's esophagus, part of which was done robotically...an eight hour surgery