On Call

Call continues to be the most stress-inducing part of my job. I was just on call last night from 6-6, which actually translated to me being at the hospital from 5:30pm-7:00am. I'm on call again tomorrow night from 6pm to midnight, then again on Friday from 6pm to midnight. Definite growth experience for me. What really causes the anxiety leading up to and during call is the possibility of having admissions and codes to take care of, on top of handling any issues arising with the patients already in the hospital on our service. When those above my pay grade decide that a patient should be admitted to the hospital to the residency service, it's my responsibility to go see the patient, get their history, do an examination, come up with a list of what's likely going on with them, and a course of actions to take to get more clarification on their situation and/or treat them. I then run all this by the senior resident who's on call with me to make sure it sounds halfway decent, then report everything to the attending physician who's on call at the time. In a given night, you could get no calls about current patients and no admits, or you could get called every 5 minutes with complicated questions and have to do a dozen admissions. It's just the luck of the draw. Amidst all this, if anyone in the hospital decides to go into cardiac or respiratory arrest, you have to drop everything and run to take care of them. This will probably take at least an hour by the time you've run the actual code, then dealt with the necessary calls and documentation afterward. Time management becomes critical.

This all is so hard for me because I like to take the time to figure a problem out and totally wrap my mind around it before taking care of it. If I have a bunch of disorganized tasks that involve concepts I don't fully understand with additional tasks getting thrown at me, it is very difficult for me to function. With time constraints, there is no way I can fully wrap my mind around everything and complete all my tasks perfectly. As a perfectionist, this is a hard pill to swallow. Also, the more times I'm on call, the more things I realize I need to be doing during a shift, so it feels like the more experience I get, the farther I get from adequacy. This is quite disheartening, since everyone knows you're supposed to get better at something the more times you do it.

I'm working on thinking through my call duties in manageable chunks. I know how to round on patients. I know how to take a history. I know how to do a physical exam. I'm trying to think of the call night as a series of individual tasks I know how to do as opposed to a nebulous, monolithic impossibility. There are things I still don't know how to do, and I'm trying to have the perspective that I can learn and get better at each of these individual things, instead of seeing them all as a unified, insurmountable obstacle.

Tomorrow brings a new rotation for me. I'll be doing Emergency Medicine, so I'll be in the ER, seeing patients and working with the ER attending (full-fledged) physicians to get treatment initiated and either get the patients back home if they aren't too severe, or passing the patient's care on to another physician who will admit and care for the patient in the hospital. Word has it I'll be able to do a good amount of procedures while in the ER. This includes doing stitches, starting central lines, pelvic exams, chest tubes, etc. That part should be fun. Since we have clinic as an ongoing part of our training, I will actually spend tomorrow morning in clinic (typical primary care doctor's office) seeing my patients there. And, yes, call continues regardless of which rotation I'm on.