Foreword:
Persistence was never my strong point. If it didn't come easily, or quickly, it usually just didn't get done. So many half-finished knitting projects are languishing around the house as a result.
But it doesn't mean that I can't strengthen that frail muscle of perseverance. So here's to re-newed beginnings, a re-restart, another grand re-openin', another show.
Here's to another blog entry, and hopefully, more to come.
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In the past, when I would declare with melodramatic sorrow that I was on call on the next day, many friends would look askance at me and hesitantly ask, "But...that means you can still come out tomorrow for a little bit, right?" At which point I would return their confused look, because it seemed clear to me that it meant I would be in the hospital for the next 24 hours.
Reflecting on the confusion of what constitutes 'being on call' made me finally realize that people in medicine have their own weird little languages and kingdoms and phyla that years of 'House' and 'ER' still have not elucidated to the general public. I mean, what other people still use pagers? The last time I spotted them actually being used in pop culture was in Clueless, the movie from 1995. Last referenced in modern times by 30 Rock in the form of Dennis Duffy, the Pager King, who with his mullet and hockey-and-classic-rock loving ways, is a living tribute to the late 80s/early 90s.
But a little illumination: there are, in fact, different types of call - at-home call and in-house call.
Some residents, such as senior medicine residents or very specialized doctors like dermatologists or oral maxillofacial surgeons, take call - that is, caring of patients or taking consults on patients related to your specialty - from home (AKA at-home call or pager call). They only come to the hospital when their ancient bulky pager beeps, and only when the person paging them lays out their case insistently and fairly begs them to come in, i.e. patient is practically dying, or at the least, very, very sick. Thanks to smart phones, most of the time dermatologists don't even have to come in: take a pic, click send, and they'll call you back with a diagnosis.
On the other hand, OBGYN residents, regardless of seniority, most always take call from inside the hospital (AKA in-house call). We live for 12-24 hours inside the hospital, without contact with the outside world. (One of my residents truly thought that the hurricane devastating our area was called Hurricane Sally. SALLY. Not much better: when I'm on call, I only know if it is raining or sleeting or snowing when I'm actually being soaked on my walk back home after call, because we have no windows nearby on Labor and Delivery, and thus never see what's happening outside. For me, weather is something you experience, not something you look outside and prepare for.) We are working most of that time, taking care of the post-surgical patients, sorting the pregnant women who are actually in labor/having actual problems from those who are not, trying to get babies delivered, and arguing extensively with the ER, for whom we are basically the female organ examination-and-ultrasound service. We still, unfortunately, must carry our shrieking, bulky pagers.
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| Things we do on call: slap things on unsuspecting residents' backs |
Why must we be in the hospital? There usually are not that many OBGYN residents in each program (unlike the armies that constitute Surgery and Medicine), and because of restrictions on duty hours, we already have the minimum possible number of residents on call. The attendings at our program are usually not that active in managing the course of their patients' labor; that falls to us. Emergencies and labor can pop up at any time, usually truckloads at a time.
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| Things we do on call 2: model the latest in recyclable scrub coat fashions - note the hand-torn fringe |
In any case, I guess it would be hard to deliver babies or rush ectopic pregnancies to the OR from the screen of my iPhone. (Darn. Work on that, you geniuses at Apple or Google). And I, for one, have never been on an empty Labor and Delivery. An axiom of the universe: THERE WILL ALWAYS BE SOMEONE IN LABOR AT ANY GIVEN TIME OF DAY.
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| Things we do on call 3: print out prescriptions for the patients leaving the next day |
I've heard rumors of other programs in the Midwest where senior residents stay at home and just come in for emergencies or surgeries like cesarean sections. When someone at the end of their third year of residency blithely posted on their Facebook wall , "Last night call ever!", I seethed in jealousy AND confusion for a few minutes, and then had the courtesy to click LIKE. Even though I suppose this would be feasible since I live half a block away from the hospital (the view from my 9th floor apartment looks squarely on the hospital facade), which is both convenient and depressing, with the volume of deliveries at my hospital, I would be woken up at least three times a night to run back over for a c-section, and would likely spend the rest of the time sleepless, dreading the shrill call telling me to run back to the hospital again.
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| Things we do on call 4: take care of babies (only while inside the mother) |
Plus, years of residency have made me neurotic. Whatever little I can control on Labor and Delivery, I MUST control it; this means doggedly going between the intern and the second year and the third year resident, making sure everything is taken care of, and at the minimum, okay.
Also, sidebar, call rooms: NOT glamorous. Not, at least the ones on my Labor and Delivery, used for any type of 'Grey's Anatomy' extracurricular activities. Not even used for more than two hours at a time, usually. They are small and cramped. They are really, really cold. There are rumors of bedbugs in the past. The sheets are changed, sometimes, I think (though, to be honest, we're usually so tired that we don't really care.) There is this giant conical thing protruding from the ceiling with a giant hole in it, which I refuse to examine closely in fear of what it might be, though I hope it's from some sort of flooding from the floor above that resulted in blistering of the ceiling? I don't know, and I don't want to. I also once had a new pair of pretty running shoes stolen from the call rooms, which makes me resent the call room AND my attempt at betterment and exercise at the same time.
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| Things we do on call 5: bring a dash of the holiday spirit, in a culturally open, comprehensive, and medical way. |
In summary:
1) Being 'on call' means that you are taking care of patients in the hospital, taking calls from patients who think they may need to be the hospital, and seeing patients of other specialties that may need your expertise.
2) In house call = in hospital, AKA that resident can't (or at least probably shouldn't) hang out with friends outside the hospital that entire day. Pager call, or home call = close to hospital, AKA that resident can hang out with you until the ancient beeper calls.
3) Some specialties do not need to be in the hospital when they are on call; some specialities always need to be. The type of call and the amount are residency program dependent. (Some food for thought for those of you in medical school still considering which field to go into.)
4) Call rooms are nothing like TV would prepare you for. They are mostly unpleasant.
'Til next lesson.
Disclaimer: Take everything I say with a grain of salt. I tend towards the sarcastic (clearly). ER, dermatologists, and senior medicine residents work very hard, and pager call can be equally as stressful as in-house call if there are many emergencies that you have to come into the hospital for. Being a resident in general means hard work. And OBGYN calls are busy, but manageable. But generally, I think what I've said is true.
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