These things sure shouldn’t come cheap,
The phone, the admit, the beep
One hundred and twenty
Hours seem plenty
To forego quality sleep.
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 54 hours a week.
Christmas falls on a Tuesday this year, so that the holiday call includes everything from Friday at 8:00 AM till Wednesday at 8:00AM.
My share of the dirty job began well on Friday; I started early, moved efficiently and rounded on twelve at the first hospital, discharging 3. Our hospital nurse greatly boosted my efficiency by entering orders, filling me in on the patients, researching old charts, and placing calls. We rounded on three more at the second hospital, finishing rounds well before lunch.
I got to eat a festive meal at the clinic, pizza bought by the providers and managers. A quick nap in my office chair followed by a couple of hours of paperwork, and a hospital admit through the ER rounded out the afternoon.
Friday night I slept poorly, my sleep ruined by vigilance. Still I got through rounds by 12:30, then napped well into the afternoon. After dark, the real work started with admission after admission.
Three different patients couldn’t talk to me for three different reasons. Still, it makes the drama and the irony more poignant when I carry on a conversation and have to keep redirecting my comments to the patient. And I don’t know which strikes harder, doing so with a conscious or an unconscious patient but the contrast in itself brings meaning.
Called in at midnight and back home past one, and hammered by the phone every time I got to REM sleep, I dragged myself into rounds on Saturday morning.
About 830AM I had trouble keeping my thoughts in my head long enough to write them on an orders sheet, and I simply had to rest. In a doctor’s dictation room I leaned my head back against the wall. I crossed my arms and napped for 9 minutes, exiting the real world directly to dreamland and coming back without going through non-dream sleep. I awakened euphoric. I finished my rounds by noon and returned home to try to nap again.
Eleven phone calls shattered my siesta till I went to the ER to admit a patient. I returned to the same hospital at midnight for another admission, and 8 phone calls followed till 6 on Sunday morning, when I gave up trying to sleep. Only one phone call interrupted my shower.
Sunday rounds went well and at 3 I signed off to my partner and went to the gym for a workout. Bethany and I dined out and I crawled into bed early and out early.
On Christmas Eve morning I went back to the gym. Rounds on 9 patients (with one discharge) followed breakfast out.
The hospital’s yearly culinary largesse helped keep the good humor of a good night’s sleep, and I finished rounds before noon. Preemptive napping alternated with beeper traffic punctuated the afternoon till an admission at 500PM and another at 700PM.
Christmas Eve found me responsible for 20 hospital patients. Three narcotics abusers had legitimate medical problems requiring narcotics administration. Three people had pancreatitis. Two people lied to me about drug use and four others told the truth. Terrible infections in various states of healing besieged the immune systems of five patients.
Five phone calls mangled sleep between midnight and 100AM, mostly concerning a psychiatric patient with no medical diagnosis; the question concerned not patient care but which physician should assume title of attending and which consulting.
The morning darkness of the 25th found me in the doctor’s lounge with a census of 11 in one hospital. For each patient I reviewed vital signs, labs, x-ray reports, consultants’ dictations and the note for the previous day before I entered the room, washed my hands, greeted all present, sat down, asked about symptoms, stood up, listened to heart and lungs and examined what needed examination, sat down again, went over the case so far, and told a joke. I spoke directly with consultants regarding three. Another six required discussion with the nursing staff.
Substance abuse, mostly alcohol, runs rampant in patient populations; today I discussed cocaine with twice as many patients as usual. A substance that leads people to sex work, it also brings on the death of heart tissue at an incongruous young age, which in turns leads me to look at the poetry of pathology.
I came home at 1230PM and lunched. I plugged in my phone and lay down, intending to have my standard 18 minute power nap and awakened two hours later, refreshed in body and battery.
We had a birthday dinner with our neighbor. Bethany came with me when I left for more hospital work at 700PM.
Every visit with a patient requires documentation. I found 64 dictations I had to review and edit; about one-third had laughable typos (for example, I said trophic changes at the ankles, and they typed terrific changes at the ankle).
Just as I finished, I received a beep from the other hospital’s ER. A young patient required admission. As I gathered myself, my beeper sounded its cheerful ring again from the other ER; an adult required admission.
I left Bethany in the doctor’s lounge and set off towards the other end of the hospital, 300 yards away. Cheerful drama and irony followed, and I returned fifty minutes later.
Tired people make mistakes. I arrived at the other hospital and realized I’d forgotten to download the history and physical I’d just dictated from my pocket machine. Having Bethany do that for me without orientation and training did not rate the word feasible.
I took the elevator to the fourth floor. The patient and the family recognized me from a year ago as the doctor who plays with yoyos.
At 1010 PM we started the cross town drive. The process of downloading involved 9 distinct steps and a 3-digit code but lasted less than a minute.
In bed an hour later and promptly asleep, vigilance awakened me at 130AM. I took my own advice to get out of bed and do Something Else if unable to sleep for more than 10 minutes in bed. Yawning set in an hour later, and I slept solidly till the alarm went off 15 minutes shy of 600AM.
The beeper and phone both went off at 630AM; a patient needed admission through the ER of one of the hospitals, but I had a commitment to a C-section at the other hospital at 700AM. When mom and baby checked out normal, I called my partners about the admit.
I can’t give details but the fine points of that last admission’s turf question have huge ramifications. Things settled, I got back in the car at 800AM.
Thus in 120 hours of holiday call, I put in 28 hours in the hospital, and took 161 phone calls. I got called back in to admit patients 7 times. I got 17 hours of payback coverage that included an excellent night’s sleep, otherwise my longest uninterrupted slumber was 5 hours.
I’m napping most of the day, and going deer hunting this afternoon.