The night is now over and passed,
It left me a little bit trashed
Yet I have had worst
And it wasn’t the first
But of bad call, I hope it’s the last.
Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time, 54 hour a week position with a Community Health Center. Since August I’ve done a working vacation in Petersburg, Alaska, Continuing Medical Education (CME) in San Diego and Denver, and a trip to Mexico for our daughter’s wedding.
I start early because I can’t sleep past 5:30AM and I get to the office at 6:40 and start plowing through documentation from the day before; every 4 hours of outpatient contact generates an hour of documentation. I walk into the exam room for my first patient promptly and on time at 8:00, and I finished the morning, strangely, at 11:45, leaving me free to sit down and work on the morning’s documentation. I even get downstairs to the lunch room, to heat up my elk meat and rice in the bank of microwave ovens. But more work piles up on my computer desktop while I eat, and drains time and energy till my nurse readies the first patient at 1:15.
At 4;45PM a PA brings me upstairs for a patient needing admission. At 4:55 I start on the last two outpatients, apologizing for my tardiness.
The upcoming holiday mandates I complete the afternoon documentation before leaving at 6:15 PM. I get home to microwave two tamales (homemade by a patient). I eat 1 3/4 and get a call from Labor and Delivery: “We’re going to C-section.”
At L and D at 6:55 I find out that the procedure needing my attention comes next; nurses tell me how much they appreciate it that I just come when called without whining first.
I fill the time with a surprise encounter with an endocrinologist, whom I hadn’t seen or talked to for months, reviewing electronic documents, and chatting with residents and staffers about the low quality of Electronic Medical Record (EMR) systems. I bring up MedTech32, New Zealand’s national EMR, simple, intuitive, robust, reliable, producing useful documents and organizing data well but useless in a world of defensive medicine.
Down the hall another baby enters the world and our nursery service.
8:00 PM I start to scrub and my beeper and phone go into meltdown mode. I have the nurse call the operator to hold calls.
The section goes well, the red-haired boy cries, pinks up, then starts to struggle for air. Drama enters my world while the beeper and cell phone restart insistent chiming.
The baby stabilizes in the recovery room with some oxygen, his nose stops flaring with every breath and he pinks up again.
At 8:30 I get to the telephone and start to make calls; two patients await me at the Emergency Room. The medical nursing floor has a number of questions and I suppress the urge to scream while the jolly nurse kids around before getting to the point.
With three places needing me simultaneously, I change out of scrubs and make more calls.
The beeper sounds again for the same ER across town, the call tells me that one of those patients in fact belongs to another clinic, and my tension plummets by a third.
At 9:30 the ER patient comes with a family context, a bad infection, and a full back story. But she doesn’t want to talk and extracting history takes little time, the physical less, and the dictation but 6 minutes. Putting the orders into the computer lasts as long as the previous steps put together. I get home at 1030 and into bed at 1115.
Five minutes before midnight the phone wakes me out of a sound sleep, and I head back to the ER that I just left.
Cigarettes stole the breath of a young person who continues to smoke and doesn’t want to quit. Carbon dioxide has built up while oxygen plummets and the short-term starts to look as bleak as the longterm..
Despite the gasping, the patient has a tale to tell. I listen and take notes, and eventually I ask my series of 84 yes and no questions. The BIPAP mask cuts the physical short, I can’t remove the machinery without endangering the patients life. Again, I spend more time at the computer than I did with the patient, but when done I go back into the 8 bed ward and exchange pleasantries with a PA I knew from my Indian Health Service days; she came with a relative and a story full of drama and irony.
I arrive home at 1:10AM. Sleep comes with difficulty, and arrives fragmented. No calls comes before I give up on slumber at 5:00AM.
I had a bad night on call, though I have had worse. I will have more call nights, with babies and children, but none of them should be bad.