The "On-Call" Misnomer

Okay, so I've talked to various family members (and others) when making plans, etc, and I've mentioned that I can't go to family function X, or activity Y, or project Z because I'm "on-call" on the scheduled day. The conversation has usually run the course of "well, can't you come along and then just leave if you get called in?" The answer: No - this is because 95-99% of the time, when a physician is "on-call," it means he works all night. It doesn't mean hanging out at home 'till the phone rings or the pager goes off; it means that he (or she) puts in a normal day (leaving the house at 5:30 AM to go to work and then working all day), then staying in the hospital and working all night and well into the next morning, sometimes even past noon the next day. Granted, on a very good call day, you may get 5 hours of sleep during the night, but generally it's 3 hours of interupted sleep or none at all, and you put in a solid 24-36 hours non-stop.

As it so happens, I'm on call right now, and I'm writing this blog during the first break in the action that I got today (it's now 3:55 AM) . During the course of the day, I did anesthesia for two surgeries lasting around 7 hours each. They were both laparoscopic robotic surgeries, which I fondly refer to as "robot attacks." Afterward, I picked up the code pager from another resident, and suddenly became responsible for the well-being of around 30-40 post-operative patients, some of them still breathing through a tube. It also becomes my responsibility to quite literally sprint to the bedside of any crashing patient in the hospital (which covers about 4 city blocks) when everything is going awry. During the night so far, I was called to two codes where it was my job to get to the head of the bed and ensure the patient gets oxygen, either by mask ventilating the patient or rapidly sedating the patient and inserting a breathing tube while other residents perform chest compressions/CPR. During the course of the night, I ended up treating some patients with astoundingly high blood pressures, balancing electrolytes, intubating crashing patients, giving potent medicines (called "pressors") to patients with extremely low blood pressures, writing treatment notes, putting in IVs and arterial pressure lines, treating post-op pain, and managing epidural catheters. Despite the crazy hours, stress, and messes (I've even got blood on my shoes), I can still say I love this job.

*2 hours later*..... Okay, I'm back... change that to 4 codes during the night! It's now 5:20 AM and I just got back from two more. All four crashing patients survived (so far). Crazy night! Anyway, the last interesting thing that happened was after my first patient's surgery this morning. I was rushing to get the room turned over and preparing the anesthesia drugs and equipment for the next patient. In the process, I didn't notice that one of the laparoscopic surgical screens was located a few feet away just above my line of sight but lower than the top of my head. That being the case, I rushed over to grab a new anesthesia circuit and clocked myself squarely across the top of my head with the corner of the monitor. It was similar to stubbing a toe... you know, when you can't really focus on anything other than the ardent pain that is searing into the depths of your soul. I paused and took deep breaths for about 10 seconds while holding my head, then brought my hand down only to notice that it was covered in blood. The gash in the top of my head dripped down my forehead and I had to stick some gauze on it and hold pressure to stop the bleeding. Anyway, I couldn't really cancel someone's surgery because I cut my head, so I went and put on gauze and two surgical caps to hide the blood (I figured it wouldn't be very confidence inspiring for a patient to see blood on the anesthesiologists cap), and we proceeded with the next patient's surgery. When I got a chance, I checked with one of my collegues (I couldn't see my wound because it was square on the top of my head), and he said it was borderline whether I needed stitches. I figured I'd just forget it. Even if it left a scar, at least my hairline would hide it. Anyway, other than the head gash, it's been a pretty typical call day. I'll even get to go home in a few more hours!