I have put off posting over the past month-plus, simply because life has gotten so commonplace. For the past two months, I have been on call at the hospital every fourth night. On a good night, I will get three hours of interrupted sleep (i.e., awakening to answer pages in between periods of rest). On a bad night, like the one I experienced this past Friday, I will get none. Okay, this is not quite “running” material, but I feel like writing about this.
On a call day, I arrive at the hospital at 8AM. I see the patients currently on my service and try to tend to all of their needs before: A) a new ICU admit arrives and I have to tend to him/her, B) the hospitalist team caps and the admitting pager is handed over to my team, or C) 3PM, when the hospitalist team hands us the admit pager regardless of the number of patients they have admitted. At 3PM, the tough stuff begins. This past Friday, I reached my patient limit by 7PM, but had not been able to finish my work on the old patients yet, and thus spent the entire night playing catch up in between dealing with runs of multi-focal atrial tachycardia, supraventricular tachycardia, and ventricular tachycardia (this stuff I actually enjoy quite a bit - it’s typing up admit notes that kills me). In any case, after 11PM during a weekday or after 2PM on a weekend, I am also cross-covering on half of the medicine patients in the hospital, which can be stressful, although normally it’s fun to care for different patients. This also gives me more time in the ICU to tend to some of the other patients I may otherwise have never met. The following day, I need to have seen all of my new admits as well as my old patients by 7AM, when my team begins making rounds on the patients that were admitted to the general wards. At 7:30-ish, we receive the summons from the critical care team to round on ICU patients. While this is demanding, it’s usually the most rewarding part of the post-call day. The hard work put in on sick patients is either completely torn apart by the critical care team, or else you’re a super-doctor for saving someone’s life. Finally, after ICU rounds, we finish rounding on the other ward patients, and then have to have everything done by 2PM, because if we don’t, the residency program is in violation of the federal work laws. Some of us (i.e. first year residents, aka “interns”) are more grateful for this law than others. No more House of God days, although sometimes it feels quite similar to what Samuel Shem describes (minus all of the wild sex parties going on in the call rooms - I want to know how he had time for all of that anyway).
I think the most difficult aspect to what I do is how I feel both physically and mentally if I have not slept in two days. For one thing, I become emotionally labile - funny things are really funny, and sad things are really sad. One time post-call, I was rounding with the ICU team, and I heard The Naked Gun 2 1/2 coming from a television in another room. Based on what I was hearing, I could visualize in my mind Lt. Frank Drebin’s expression as he says to the cocktail waiter, “Give me the strongest thing you’ve got,” and the waiter brings over a large body builder. With that, I began cracking up laughing in the midst of presenting a very ill patient. The attending stared at me, and yet I continued to laugh…and laugh…and laugh. Totally inappropriate. On the other hand, I recently had a patient become quite sick the morning after a call night, and wondering if we could have done something different, I started to cry. And I cried…and cried…and cried. It was horrible. After a good night of sleep, everything was fine.
At this point, I am on the verge of exhaustion. I’m tired all of the time - the day after call, the next day, and the next day I might feel semi-normal again - but then it’s time to be on call again. I have been skiing a couple of times, but have not run in nearly two months. And on days off, I have difficulty getting myself outside to run because all I want to do is sleep. But I can’t sleep, because I know I should be making use of my day off to accomplish what I have put off for an entire week. And the cycle continues…
At the moment, I am sitting here in the semi-darkness, listening to OK Computer and feeling quite relaxed. I just posted my current thinking to my non-running blog. That’s all for now - time for bed, for tomorrow is another [on call] day.