Last call

I've only been able to post photos on this site lately - it's just been so hard to find the time to write anything. It is, however, my last weekend call (for this rotation), as I have a golden weekend for my last weekend next week. I've got lots of stuff to catch up on at home, but will try to finish up the whole "choosing my medical specialty" story soon. Enjoy the weekend guys!
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Only 30 more hours until a day off

Just need to get to tomorrow. Whew, I am pretty tired.
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Trying to make it to the weekend

I logged 79 work hours last week (from Sunday through Saturday) and I can't remember if I logged all my hours doing dictations at home. I haven't had a day off since I started this rotation last Monday and won't get one until Sunday. I generally get to work by 6am and leave somewhere between 6 and 6:30 at night. And call is from 6am until about noon the following day (which is what I did this weekend).

Logistically, this means I leave before anyone get up up in the morning (while it is still pitch black outside), and get home in time to (hopefully) have dinner with the family, play with the kids for a bit and then help put them to bed. Fortunately, they have been going to bed a little bit later during the summer (closer to 9pm) which leaves me a little bit more time with them in the evenings. Of course, this makes it harder on my husband who has to get them up for school in the morning so that he can make it to work on time (It'd be great to have a nanny and daycare, wouldn't it?). So this means after 9pm, we've got dinnertime clean up, and then whatever dictations I need to do, and then try to get to bed at a reasonable hour so i can be up early in the morning to do it all again. What usually happens though is that I am so exhausted at 9pm, that I fall asleep in the kids room (sometimes I lay on a mat in there when they go to bed) and get up at 2 or 3am, freak out about all the work I have to finish and then stay up until it's time to go back to work.

It's weird how there is this "rule" of working a maximum of 80 hours a week, and then seeing how everyone really has to try hard to stay under these limits (I've definitely gone over before). Overworking is certainly not limited to the field of medicine but I have to say it is much too common for my taste. The other thing I think people don't always recognize is that when I am at work, I am pretty much working the whole time I am there. There really aren't many breaks or periods of downtime unless I consciously remember and force myself to a) eat something or b) sit down and take a break. And that is assuming there is enough lull in the workload to dare try it. My pager always seems to go off the second I walk into a restroom.
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Need a day off

So I'm almost done with my first week of one of the tougher ward months of my intern year, and I am pretty tired. Unfortunately, my first day off won't be until next Sunday (also the first day I will actually be with my kids when they wake up in the morning). Sigh.
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Finally

Okay, so I am post-call on my very last day of my critical care rotation and wow, was that a crazy month. I was just telling one of my good friends the other day that I don't even think I could describe how busy I have been (both at work and at home) because I don't think anyone would believe me. I know most medical students and residents have had days where you are so busy you forget to do essential things like eat lunch or even go to the bathroom, but I have to say that on this month, that was the norm. I think I was in fluid homeostasis, neither drinking any water nor needing to pee either, which is crazy. I'm trying to hydrate myself now.

I don't know how many of you have experience with buying a property (we don't) but slap that on top of everything that is happening this month, and it's beyond chaos. I started intern year, my husband finished his fellowship (he took three days off - we really needed the money) and started a new job. We're about to close escrow and I haven't even started packing yet. I had to sneak away to the call room for five minutes before evening sign-out so I could call the movers and book a date.

For those of you who are wondering how we could even afford to buy a place, we did the physician home loan program from Bank of America (no/low down, no mortgage insurance fees (at the cost of higher interest), student loans not included in your debt-to-loan ratio). Considering we have a negative net worth of several hundreds of thousands of dollars, it's a miracle that anyone would give us a home loan in this economy.

Anyhow, I'll be starting a much less intense rotation on Monday, although we will be starting what I hope will be the last move we undergo in a long while. Hopefully we can be settled before my next block at the end of August, which will be another chaotic month. Intern count: four weeks down, only 48 more to go.

I'll be back soon to finish writing about choosing my medical specialty. I have to dictate my off-service summaries.
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New call record

Okay, so not only did I not get a wink of sleep on my last call night, but I didn't even get to go the call room. Only a few more days until this block is done, and only one more call night on this rotation - hooray! This month has been so crazy.

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More breaking news: call is brutal

Today I left my call only about three to four hours earlier than when I would have normally left for the day on a regular workday. Funny how when you really think about it, post-call days don't really give you that much time to catch up on sleep compared to just working through through the whole day. I'll take what I can get, but it's pretty rough to say the least. Of course, people have been doing this for many years in medicine (why?), so I've really got nothing to complain about, right? It still amazes me that the medical field is such a hypocritical one in that it basically doesn't practice what it preaches. Take care of your health, but don't model after me. If I can contribute anything to the field of medicine as a whole when I am done with this whole process, I hope it will be to be the best physician I can to my patients, AND to change the practice in such a way that it allows for physicians to be human as well. And I won't even go into what I'd like to contribute in terms of my personal life. What a crazy profession.
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A much needed break

Yesterday was my first day off (that wasn't a post-call day) since I started residency, and boy was I ready for a break. Because of the holiday, I was fortunate enough to have two consecutive days off. Unfortunately, I am on call again tomorrow and will likely have at least 6 brand new critical care patients in addition to my own to pre-round on. It's nice to have a break, but it makes it tough to catch up on everything that has happened when you go back to work.

In any case, I am now halfway done with this rotation and after tomorrow's call, I will be more than halfway done with the calls for this month, thank goodness.

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This call thing is pretty difficult

So I have been on call twice now since starting residency, and I have to say it's definitely a challenge. In many ways, I think being totally busy all night might actually make it easier than being sporadically busy at times spaced out just so there is no way you can actually get to lie down and rest for a few minutes. I really think that this system has to change - it's really not good for anyone to have sleep-deprived doctors presenting information, placing orders, and signing out critical information to other people. But that's a project that'll have to wait for now.

Now that there is a 30 consecutive hour rule (you technically have to go home after 30 hours), it's probably a lot easier than it could be. But still, the other day I was thinking that in one overnight call, I was putting in 75% of what is considered to be a normal workweek by traditional standards. And while I had similar calls as a medical student, it was never as busy as it is now (the pager never stops these days). It's nearly impossible to keep up, since there are so many people who need you to do something all at the same time.

It really hit me around midnight of my first call (when I had been at work for 18 hours), when I felt like I was still feeling okay, but that I still had twelve more hours to go. I've found that I really start to tire out right around pre-rounding time, when I am supposed to working fast to finish my notes and collect all the tiny bits of information needed to present on rounds. It's particularly difficult since it is often the first time I can sit down (at a computer), and then the fatigue totally hits me.

To put things in perspective, my first month is on a critical care unit. As a med student, we only carried one or two patients on our critical care months, since these patients are often very sick with lots of complicated things going on. Well, talk about abrupt transition. Somehow, between being a medical student and intern (really only a matter of days), the workload progressed from two patients to up to eight or even ten critical care patients, which is definitely a challenge to say the least. I keep going in earlier and earlier to pre-round, since it's becoming harder and harder to get everything done by the time we round in the morning.

Anyhow, I've got a few things to work on before going to bed (there is a lot of logging of patients, procedures, dictating, etc.) so I better stop now. I'll keep trying to post as much as I can (but probably not on call or post-call days).
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