When nearing the end of my shift
I get an emotional lift
In the dark or the light
I’ll be at it all night,
What? No call? Such a gift!
Synopsis: I’m a family practitioner from Sioux City, Iowa. In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work. In June of 2011 I joined up with the Community Health Center, which provides care for the underserved. I’m now working part-time, which, for a doctor, means 48 hours a week.
Illness does not respect the clock or the calendar. This central fact remains an undercurrent in the world of medicine. Doctors have more visibility during business hours, but when the world goes home for supper, every medical practice must take into account afterhours medical needs.
A solo practitioner takes call all the time unless he or she shares a spot in a call rotation. A group practice rotates call amongst the members. Some practice models close in the afternoon, advising patients to call 911 or go to the Emergency Room if they have a medical emergency.
In the last two years of med school and in the three years of residency, I took call in the hospital. I learned to pack for an overnight in less time than it took to shower. Most nights I would snatch minutes (rarely hours) of low quality combat sleep but the work went on all night.
I checked the call schedule last week and found my name for Tuesday.
We talk among ourselves about the emotional preparation we do for call, at the Practice Formerly Known As Mine we referred to “having your flak jacket on.”
We always carry a certain amount of fear of being overwhelmed. We face the possibility that the chaotic distribution of the tasks which must be accomplished will overwhelm our time available to accomplish them. Or that our emotional resilience to the really tough things that we do, especially tragedies involving children, or people dying young, will be taxed to the extreme.
When still active in obstetrics, I worried that I would have to attend deliveries in two hospitals at the same time. In fact on more than one occasion I went from delivery room to delivery room in one hospital to the delivery room in the other hospital; my personal record for deliveries in one night stands at five. I left that part of my practice and I hope I never best that record.
A part of emotional preparation for call involves finding the break point, a goal I set myself, a time to reach, and if I can just get that far I can handle the rest of the call. On most weekend calls that hour comes at noon on Sunday. Looking at tomorrow’s schedule, trying to figure out that point in the time line, I realized things didn’t look right. In short order, I found I’d misread the call schedule and that my next night on call would be the weekend.
Better than a snow day during finals, better than finding a fifty dollar bill, that realization exceeded the rush of winning a raffle.
I whistled and grinned and told jokes for the rest of the clinic session.
OK, I do those things anyway, but today with more intensity.