Wednesday, April 28, 2010

It's all about the call

I have 8 call days of internship left. 8 more to complete before the end of May. There will be many more over the next three years of anesthesia training, but only 8 more this year (Year in the academic sense. Starting and ending in July.)

Being on call, meaning staying at the hospital over night, really wears on me. Not only does it mean 30 hours shifts and lack of sleep, it means being away from my family for extended periods of time.

Being on call also has it's own language. Such as "float," "mole," "second call," and "third call." And the infamous "q."

As in q3 or q4...or even worse, q2.

Q means every. Q3 means you take call every third night. Q4, every fourth night. So, doesn't q2 just sound fun?

This is how I know that Hubster understands the language and the system. He looked over the SICU call schedule and exclaimed, "I can't believe they have you q3 for most of the month!"

Call can be stressful. Most of the bad things that happen, happen at night. No one seems to have strokes or chest pain in the middle of the day. This problems lurk around the corner in daylight hours and then pounce once it is dark.

The worst of the worst happens at night. This is when patients crash, when surgical complications manifest, when airways are lost, and blood pressures tank. It is at night that intubations are done, central lines are placed, and codes are run.

I've spent many call nights at the bed side, pushing emergency drugs, hand pumping blood and fluids, watching chest compressions being done.

But not every night. While the bad things do seem to cluster in the night hours, most nights are not full of panic and anxiety (and dare I say it...excitement.)

For the most part, call is just really, really, really annoying.

In the ICU, all the beds are open to the central nursing desk, so you can sit at the desk and have a direct line of site to each patient. It's very noisy.

Every time an infusion finishes, or every time an IV tube kinks or clogs, or every time the smallest bubble is in the line, the IV pumps alarm. There are eight patients each separate SICU bay. Each patient has between 2 to 12 IV pumps. They are alarming all the time. Each patient has EKG monitoring, oxygen monitoring, respiratory monitoring, and if they are intubated, ventilator monitors. If this fall off (which they do), or if the patient's heart rate, oxygen saturation, respiratory rate, blood pressure, or any other parameter we happen to be monitoring goes outside the set parameters (even for three seconds), the alarms go off. There are alarms dinging and ringing ALL THE TIME. The majority of these do not need responding to. But we monitor, just in case.

I hear the dinging of the alarms in my head all the time, especially in the quiet of my call room, or as I'm trying to fall asleep post-call at home.

Most things on call are easy to deal with. Orders to be clarified, labs to be followed up, pain medicines to be adjusted.

There are usually quiet moments to escape to the call room. But it is hard to sleep. I lay there, and I just know that my pager is going to go of, at any unpredictable moment. I can't relax, I can't sleep comfortably. I usually just lay there, on the uncomfortably thin mattress with the uncomfortably thin blanket, and wait for my pager to go off.

You can absolutely bet I have my call days marked on the calender and am eagerly crossing them off, one by one.


  1. Two things.

    1) I hear the alarms too.
    2) I don't remember much about my ICU nurses or doctors, but you guys are truly amazing. I never really had any scary moments, but I saw the families of those that did. I'm not really sure how you can handle doing what you do. I'm fairly certain that my main nurse was taking care of a patient that didn't make it through the night that I was staying in the ICU, and it really made me sad. Sad that I was doing so well and that my family was so happy while these people around me were going through quite possibly the most difficult thing any of them had gone through.

    And the doctors and nurses just sort of were there. Very calm and unemotional... though that really isn't the right word, I'm not sure what is.

    I just know that I was thankful for the care that I received and that there are people who are able to do something that I could never handle. So, I guess this is something of a thank you, even though you had nothing to do with my case.

  2. I complain all the time about how exhausted I am when I get home from a long day of school but when I read your posts about work it makes me think that I must really not be that tired at all.... I hope your 8 calls go by quickly and quietly.

  3. When my mom was ventilated last year, I slept in her room a few nights. The beeping was unbearable. I feel for you having to be in that environment.

  4. I have noticed that people get sickest at night. Why is that????

  5. Think its like St. Peter?" Every time a bell rings and angel gets his wings"-- Wonder if the Pearly Gates are that noisy! How I wish you could relax and sleep deeply for even 5 minutes, like hitting the snooze on the alarm clock. I know your too responsible to let go. I'll count the x's with you as you cross off call days.