Brace yourself... this is a long one!
"Post-call" is a phenomenon that is well-known to residents, but a bit of a mystery to the rest of the world, it seems. It's the day at the end of a 24-30 hour block of being at the hospital. Contrary to what some people think, being "on call" isn't about being at home and coming in if they need you. They call this "residency" for a reason. You're at the hospital, and you don't leave until it's over. Sometimes you're run off your feet, sometimes it's not quite so busy, and sometimes (rarely) it's very quiet and you actually get a reasonable rest. Then when you finally get to go home, you're generally so exhausted you can hardly think. Fortunately, for these last 6 months, I've been working at the hospital that's within walking distance from my apartment, so I can walk home. When that isn't the case, I have to drive home post-call, and I'm always praying a lot as I drive home, because I KNOW I'm not thinking all that clearly. (There is a documented increase in the frequency of car accidents in residents driving post-call.) Then I get home and eat something and shower (if I have the energy), and then fall into bed for awhile. Usually I sleep for a few hours, but I try not to sleep TOO long, because I know I have to sleep that night, since I have to go back to the hospital the next morning again. After I wake up, I often don't quite know what to do with myself. I feel like lying like a lump on my couch for the night, but that doesn't feel that good, either. I never manage to eat normally, because I have the phenomenon my friend Rebekah likes to call "gut rot" where you're so tired your stomach isn't really interested in food. I try to eat something healthy, though, because it would be easy to go those days hardly eating anything, and when you do that a few times a week, it's not good for you. It's always good if I have something I can do those evenings to keep me awake for awhile, though I'm usually not very sociable even if I am with people. Sometimes I try to do some reading of my surgical textbooks, but you can guess how well that goes! I try to feed my spirit, though often end up falling asleep again. Sometimes I just turn on worship music and try to at least let my spirit be with the Lord, even if my mind is a blur. And if I'm making less healthy decisions, I sometimes just watch TV, and then I feel even more gross! Eventually I go to bed, and sometimes I can't sleep, even though I'm really tired, because my body has no idea what's going on. Then the next morning I'm up again and back at the hospital.
I'm always more emotional when I'm post-call than any other time. I tend to cry at things that normally wouldn't bother me, or movies that normally wouldn't have anywhere near that effect on me. Sometimes I wonder if I'm going through some sort of crisis or something, until I remind myself that I haven't really slept, and it'll all look different after a good night's sleep. It almost always does!
The next day, or the "post-post-call" day is sometimes even a bit worse, because you're still really tired from the night on call, but you're expected to function as though nothing happened, and you don't get sympathy for being "post-call" anymore. Yeah, it's a little crazy.
So yesterday I was on call. Here's how the day went:
8:00 - arrived at the hospital, hoping to be able to see all my patients on the surgical floor before things got too crazy. It wasn't to be. I was called immediately to the ER to see 2 patients who needed surgical consults. I saw the one, and was about to see the next one, when I got called from the radiologist saying that a woman who had gotten a CT the night before really needed emergency surgery, because she had an aneurysm in her splenic artery that had ruptured and she was bleeding internally. So the other consult was put on hold, and we went into emergency mode. Lots of phone calls, lots of thinking on my feet, talking to the patient and her family, ordering blood transfusions, making arrangements for taking care of her. In the end, we managed to get the radiologist on call to do a fancy procedure where he fixed the problem through a little incision in her groin, rather than a big surgery, though we had the OR on standby in case we had to rush her off. Fortunately the less invasive procedure worked out.
-As all of this was going on, I was getting paged from the surgical ward and all over the rest of the hospital about surgical patients and issues with them. I addressed as many as I could over the phone. Fortunately nothing was TOO urgent, and I just told them I'd get to it when I could, but I couldn't come just then. Somewhere in there I arranged some tests that needed to be arranged first thing in the morning for a few of the ward patients (radiology gets mad if you call them later in the day on a weekend asking for tests - they usually won't do it...I've learned the hard way).
-During the aneurysm excitement, I got called from ICU. Someone else needed emergency surgery, because his incision had popped open, and his insides were hanging outside. So I was rushing back and forth between radiology where the aneurysm was being looked after and the ICU making arrangements for that surgery to go as soon as we finished with this one. More talking to families, and more phone calls and paperwork.
-I would have had to go in for that surgery, but I didn't end up needing to, so once that all got started, I left and started dealing with things on the ward. By that time it was about 2:00. Oh, I think I grabbed a bite to eat somewhere in there, on the run.
-Back to the ER to finish up with the patient I'd admitted in the morning, and to see the other one who hadn't even been seen yet. Finished down there around 4:00 or so, at which point I headed up to the ward to see all the patients I'd intended to see at the beginning of the day. Saw them all, discharged a few, followed up on test results, wrote notes and orders on all of them. Called the staff surgeons responsible for them to let them know how they were all doing. Sometimes on weekends I don't get this done until late into the night, so this was actually good timing.
-Things quieted down around 6:00, so I had dinner, and sat down for a few minutes. But only a few, because the ER called with another surgical consult, this time for a woman with a bowel obstruction who also ended up needing emergency surgery. Made all the arrangements, talked with her, told her it was quite possibly because of colon cancer (you can't exactly just say that and walk away!), called my staff who had gone home for a bit (because when they're on call, they actually go home and come in if they're needed), etc. The surgery was put on the list, and we were told she was next (after the hip fracture that they were operating on just then). We would probably start around 10:00 p.m. So I went to ICU to check on our lady with the aneurysm - she was doing great. And then around 8:00 I figured I should probably lie down for a bit, since I had no idea how long this surgery would take, and I had time. So I did, and dozed for a bit, though my pager kept going off with calls from the ward - simple stuff I could take care of over the phone.
-9:30 they called and said they were bringing the patient to the OR, so down I went. Called my medical student to let him know he should be ready. It took a little while to set things up down there, and we were underway around 10:00, as planned. We continued until about 3:30 a.m. because things were a bit of a mess inside that belly. Fortunately, it looked like it wasn't cancer after all - Thank You, Lord! Good news for her, especially since she's only 51 years old. I'd been getting calls from the ward throughout the operation about a patient who was short of breath on the ward, and another patient in the ER who we needed to see, that sort of thing, so was trying to deal with those while I helped (one-handed as much as possible to rest my wrist!) in the OR. When we finished, went to the ER to take care of the patient there, who needed an abscess drained. Did that, admitted him, and finally by about 4:15, things had wrapped up. I checked on the patient who was short of breath, and he was doing better. So I finally went to bed, planning to get up around 6:00 to start seeing my patients and get ready to go home at 8:00.
-Slept for an hour or so (with a couple of ward calls interrupting that), and then around 5:30 got called from ER again - another lady who needed to be seen by surgery and was quite sick. So I was dealing with that until 8:00, when the resident on call for today finally got there and I could hand things over to her to deal with. So much for going home at 8:00 - I still had my ward patients to see, and then had to call my staff to let them know how all their patients were doing, etc. I eventually left around 9:45.
That was a fairly busy call, but not unusually so, and I've definitely had worse! Came home and slept a bit, but of course kept dreaming about being at the hospital and having to look after sick people. And now I'm trying to find ways to keep awake tonight for a bit...hence this LONG blog post.
I actually have a break of a little over a week before I have to do this again. That's nice. Usually it's every 4 days or so. So I'll be able to recover from this one before I do it all over again.
