Tuesday, October 14, 2014

On Call

Starting in my third year of medical school I was introduced to the concept of call. At the medical school I attended, we worked a 24-hour call shift one out of every four nights while on internal medicine, pediatrics, and obs/gyne. On surgical rotations and psychiatry, we only did call until 11 pm (which sounds better, but also meant that we didn't get post-call days).

Similarly in residency, some of the specialities I rotate through have in-house call, while others have home call or no call at all. There are two benefits to being on 24-hour in-house call: getting to wear scrubs and having a post-call day :)

So far I've been on call for CCU and general internal medicine. As both of those are busy services, I've unfortunately had little to no opportunity to sleep during my call shifts. On CCU we carried a code pager for the hospital so even if I did get a break from doing consults, I found it pretty hard to sleep with the prospect that it might go off. On GIM between being responsible for about fifty inpatients and doing admissions from emergency, there's little down time during the night.

Here's what a typical call shift looks like:
on call medical school residency
protein powder oats to start the day
0600 h: I leave for the hospital.
0620 - 1700 h: The usual rounding, teaching, etc.
on call medical school residency
prophylactic eating at Grand Rounds
1700 h: The other residents whose patients I'll be covering hand over to me.
1700 - 1800 h: I finish up my work on the ward and answer my first couple of pages.
on call medical school residency
lots of walking!
on call medical school residency
it's always worth taking these stairs instead of the elevator
1800 h: I stop by the call rooms to have my dinner.
on call medical school residency
I always bring lots of food :)
1830 - 2030 h: I'm in Emergency, doing an admission. This is interrupted by a few pages from the wards.
on call medical school residency
I was on the right ward at the right time to catch an awesome sunset
2030 - 2100 h: I go up to the ward to check on some evening bloodwork and imaging. Often we order things like cardiac workups for chest pain, chest x-rays for shortness of breath, and ultrasounds or CTs for signs of a blood clot -- I can't forget to follow up on these things after ordering them! Whenever I assess a patient, I make a short note in their chart.
on call medical school residency
I try to remember to drink water when I pass dispensers on the wards! Also: chocolate :)
2100 - 2200 h: I get a page from a ward on the other side of the hospital...at least I'm getting some exercise!
on call medical school residency royal alexandra hospital edmonton
bustling by day...armchairs filled with sleeping staff by night
2200 - 0400 h: I'm back in Emergency to do another two consults, going back to the wards every so often or addressing issues over the phone.
on call medical school residency
admissions mean lots of paperwork
0400 - 0530 h: If I'm lucky, things have died down and I go back to my call room to catch some sleep.
on call medical school residency
comfortable enough
0530 - 0630 h: My pager invariably wakes me up before my alarm clock. I check in on patients whom I admitted overnight or others on the wards whom I got called about.
0630 - 0730 h: I round on the patients whom I regularly follow, writing my daily progress notes in their charts.
0730 h: I touch base with the other residents whose patients I was covering to let them know of anything that happened overnight.
0800 - 0900 h: I meet in the conference room with the team of physicians who will take over the new admits (we don't necessarily follow the patients we admitted overnight; they are distributed amongst the various staff). I present the patients whom I admitted.
0900 - 0930 h: My team has already started rounding; I join them briefly (they'll prioritize seeing my patients, so that I can leave). After I've done any outstanding dictations from overnight, I'm free to leave -- usually by 9:30 am, but occasionally 10:30 am on a busy shift. I find that the staff are good here at getting residents out early post-call. Where I did medical school though...not so much.
on call medical school residency
Time to leave! Sunny call days and rainy post-call days have been happening too often.
1000 h: I get home and enjoy the rest of the day off (mostly napping and eating all of the food in the house).

At least the time goes by quickly when you're keeping busy! Today's another one for me...let's hope for good call karma :)

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