Tuesday, June 28, 2011

Tachy Med Student: First Call by the Hours

When I finish writing this I have to go to take a walk or ride my bike or I am going to fall straight into a deep level of unconsciousness. 

This is my best post-call-I-really-don't-hate-my-pager-face.

"On Call" - It's a phrase I've been both dreading and looking forward to for years. 

On the one hand, it means a pager constantly strapped to your body and the requirement of leaping directly into a state of coherence regardless of how deep into that Natalie Portman dream you were. 

On the other hand, it means a little more responsibility (still heavily supervised) since the care team is smaller, the surreal world of a buzzing hospital in the middle of the night, and it feels like a landmark in my medical education. 

So what does it look like? Obviously there will be a lot of diversity, but let's just look at my very first one. 

Monday, 6:45 am: Arrive at the hospital. Spend some time on the phone with a nice IT guy named Larry who helped me sort out my computer logon (after 5 days...finally). Read/study about recent patients.

7:30 am-12:15 pm: Meet my Attending at his office. Clinic all morning. I did my first digital rectal exam. At least my fingers are small. 

12:15 pm: Buzz in late to Tumor Board. Indian food. Overwhelmed by imaging I don't yet know how to make sense of. 

1:30 pm: Observe a thoracic surgery. Also observe a new PA student scream when forced to touch a piece of tissue, and hide behind the surgeon for fear of being splashed. She's not going into surgery. 

4 pm: Pick up the student pager from the call room, leave my overnight things (backpack, clean scrubs, toothbrush etc.)

5 pm: (When call starts) Page the resident on call. No response.

5:05 pm: Scrubbed into another thoracic surgery. 

6:15 pm: Page the on-call resident again. This time he calls back. I introduce myself, and tell him I'm on call with him that evening. He gets my name wrong, and informs me that nothing is going on, but he'll let me know. I then realized my pager was dead and went on a hunt through surgery and the ICU for a AAA battery. 

6:20 pm: Success. Startling pager beeping may now begin.  

6:25 pm: Cafeteria. Mint tea, honeydew melon and hummus with pretzels for dinner. Two apples for the road. 

7 pm: Page the Physician Assistant (PA) on call, check if he has anything I can do and ask where I can use a computer with internet for research. 

7:10 pm: Hanging out with the PA, learning about the indications for splenectomy. 

9 pm: I've read way too much about indications for splenectomy. Head to the call room to get some sleep. Only get lost once.  

9:10 pm: Notice sutures tied all over various bars in the call room. Realize this is an awesome time to practice.  

9:13 pm: Realize I really don't remember how to tie suture. This is essential to this rotation. I should probably learn again. 

9:14 pm: Decide the call room has a very odd assortment of objects: normal things like a bed, desk, toilet, sink, but also ports for oxygen in the wall, baskets, an empty cardboard box, and plastic drapes in the drawers. I'm fairly certain it used to be a patient room. However it's location - stranded behind the copy room - is a little odd. 

9:16 pm: Climb into the very industrial call room bed. I'm only a little disconcerted by the fact that the sheet is so thin I can see through it. 

9:45 pm: Still lying awake.

10:30 pm: Probably fell asleep.

11:36 pm: Leap out of bed to beeping. Manage to read the pager properly and call back, find out there's a consult in the emergency room (ER). Open the door. Stop. Remember my shoes. Pull myself together. Go see a patient in the emergency room. 

(It is now Tuesday morning)

12 am: Meet the resident and talk through the case. He is an Indian man with a lisp. He wants to be asleep more than I do. He asks if I have questions but his eyes say he hopes I don't. 

12:30 am: Use a computer in the clinic area to work on writing up a History and Physical for the patient. See at least two surgeons who are not on call still working. Rule out surgery as a specialty for my future (again). 

1 am: Still writing and researching patients - get another page for a consult. 

1:15 am: Introduce myself to the patient in the ER. The response, said with some startled fear, "You're not the surgeon are you?!" No. Thank goodness for both of us, I'm not the surgeon. Discuss the case with the resident, get the patient taken care of. 

1:45 am: Find that the door to the hallway outside my call room is locked. Bother a security man who bears a strong resemblance to Igor to unlock it. 

Seriously - uncanny. 

2 am: Crawl into that industrial bed again. No more pager beeping. There was, however, some extensive construction to the wall that formed my room beginning around 5 am. I learned that even while the pager may be quiet, a hospital really isn't. 

5:30 am: Completely awake from all the clamor. Get up, change clothes, do some morning studying. Eat a PBJ sandwich that I packed for breakfast. 

6:30 am: Meet my Attending in the operating room. After some delay, scrub in on another surgery. 

10:15 am: While waiting for the next case to be ready, the Attending and myself go to discuss a couple things with the rotation coordinator. Upon seeing me:
Her: "What are you still doing here?"
Me: "I'm still doing surgery."
Her: "You're supposed to be off at 8 am."
Me: "Well that's all right, the resident knows that and there's no one paging me."
Her: "But you have to leave by 10 am."
Me: "O."
My Attending: "She will miss all the fun."
Her: "Sorry, she has to go."
Me: "Too bad..." 

10:30 am: Peace. OUT. 

And so it was only like 28 hours. And my fragmented sleep probably totaled 4 or 5. It could have been much worse.

Maybe it will be. 

I have to do it again on Thursday. 

Still. The anxiety of new things for me is primarily in the logistics. Questions like:
"How do I use the paging system?" 
"Where's the call room?"
"How much food should I bring?" 
"What if the call room dungeon monster attacks me while I'm sleeping?"

I found that while people may look like Igor, everyone's pretty helpful. And now that is behind me. Call 1/millions - done.

Recipe post soon I promise!

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