I survived an overnight call, and so did my patients, but I am extremely glad that this only happens once or twice a month. I can’t imagine surviving this for three – or five – years straight. (Although, again, the chiefs here are pretty much on continuous call. I’m trying not to think too much about how that works.) This morning wasn’t too bad, since I got a total of two hours of sleep somewhere in between, in pieces. But when the ER paged me around midnight, I remember being on the edge of hating the whole world: – the operator for paging me – the nurses for calling the operator – the ER residents for having consulted me – the patient for having picked midnight to come in – and the hospital for existing. I don’t know how people manage to cope with this continuously. Once I woke up, it was better. Maybe that’s the key: not sleeping at all, because then no one wakes you up. 

Actually, surgery consults are pretty straightforward to write, which saved me yesterday. The chief complaint is almost always abdominal pain, and if not, it’s close enough to serve. The history consists of a few pertinent rote questions: where is the pain? nausea? vomiting? diarrhea? blood anywhere? fever? chills? The end. I was in the room with the medicine intern for a few minutes, and then fortunately for both of us we managed to disengage and work separately. The poor woman was asking about sore throat, skin changes, sleep habits, etc, at midnight! I’m sure she would be in trouble with the attending in the morning if she hadn’t. I love the surgical review of systems, because it’s about the same as the history. Nothing extraneous in there.

Somewhere in the wee hours of the morning, I found myself with two consults in the ER, one heading for the OR, and a semi-crisis on the floor – all things I ought to have been running past my senior, except I couldn’t find him. I was just starting to consider who would be in more trouble, him for disappearing, or me for doing things on my own, and what other surgery residents might be in the hospital, and with enough time outside the trauma bay, to handle my questions, when the senior turned up, wanting to know why I hadn’t paged him. There was nothing we could do but shrug our shoulders at each other. The poor senior, who was handling both my general surgery consults, and the specialty consults as well, was being paged nonstop, and found himself having to call an attending with a list of patients every couple of hours.

In a strange kind of way, though, call is fun. It’s like surfing or skiing: always on the edge of flying out of control. The challenge and satisfaction lies in staying on top, riding the wave and not getting buried by it.

This night also marked my surrender on the old-fashioned practice of examining the patient before obtaining lab values and imaging. When called by an ER resident with CT scan and white count in hand, it’s simply more efficient to look at the CT, copy the lab numbers, look up the past medical history online, and then walk into the room. That way you know what you’re getting into, and don’t waste time on red herrings. Also, the patient only has to go over the most recent events in detail. For the rest, you can do a checklist: “Ok, we’ve discussed the abdominal pain you’re having right now. You have high blood pressure, right? Taking hctz and lisinopril? No diabetes. No heart attacks, but you had a stress test last year, right? Any kidney problems? Any strokes? You’ve had a colonoscopy within the last five years, and your only other surgery was an appendectomy, right? Allergic to penicillin and morphine; anything else?” Not at all what they teach in medical school; but you can turn around a consult in fifteen minutes that way, and have it written up by the time the senior gets down to the ER. Which is important, because it’s only ten minutes before you get paged with another urgent consult on the other end of the hospital. Plus, the patient feels slightly less frustrated about having to repeat themselves over and over to every new person who walks into the room.

(There’s an axiom: No one calls a doctor with good news at night or on the weekend. If you get paged on Saturday evening, it’s because there’s an urgent problem.)