sorry to bother you, but...

i had my 3rd of 7 days on-call last friday. all things considered, it wasn't too bad. things did get a bit gnarly for a few hours when it was brought to my attention that a patient was in danger of dying at any second due to a previously undiagnosed aortic dissection. once that was dealt with, it was basically smooth sailing.

i tried explaining to a non-medical type what being on-call means, and why it can suck. it basically means that you are the person in the hospital who takes new admissions to your service. for me, it currently general medicine. in my opinion, the admitting new patients is not what really sucks, but rather it's the coverage of other patients that drags me down. what i mean is this--i am on call every 4th night, which means i stay in the hospital for 30 straight every 4th night. on the other days i go home around 4 or 5pm. what happens to my patients between 4pm and 7am the next morning? the on-call person takes care of any acute issues that arise. when i am on call i cover the other patients. since it is every 4th night, there are 4 total interns, which means that on any call night there is 1 person covering for 3 other people. the on-call person is really there to deal with acute issues, but this, as you will see, is generally not what happens at all. what tends to occur is that the on-call sap gets called to straighten out items overlooked by the primary team during the day (ie, things they forgot) as well as answer the inane nighttime requests of patients, including, but not limited to: requests for more pain meds, requests for sleeping meds, requests for enemas (no, i am not joking), requests for explanations of why they are here, etc. the second set of requests comes from nurses, asking for orders for tylenol, restraints, and all kinds of other things that don't require immediate attention by a doctor--or anyone for that matter--at 3am.

the latter are difficult to deal with in that initially, when interns are new and inexperienced, they take everything very seriously. this is ok, but at some point one has to triage these late night calls as there are up to 40 patients being covered by 1 intern (although it's usually closer to 20). once they have some experience they learn that not everything they are told by a nurse is a) true, and b) needs immediate attention. then it almost becomes a "boy who cried wolf" thing with the nurses requests--there are so many garbage requests (say 85%, while certainly less than 5% are true emergencies) that one becomes inured to them and eventually is less likely to respond quickly, because it's so difficult to tell when something is urgent. i know this sounds callous and unreasonable, but it's physically impossible to run full-speed to every "emergency" called by nurses when it turns out that the situation is not as it has been described. a few examples--i got called that a person was "unresponsive." i tear-ass down 4 flights of stairs into the patient's room only to discover that he was not in fact unresponsive; he was, in actuality, verbally abusive. my second example is a call that a patient was "coughing up blood." once again, i run like a mad-man to the room only to discover the source of the hemoptysis (medical word for coughing up blood) was from a nose bleed, which the patient informs me she gets all the time. these were not emergencies. next time the same nurse calls me i am less likely to trust her judgment. obviously, there are certain things that one has to take seriously everytime, but at some point, one cannot physically be in multiple places at once and i will be less likely to believe this rubette (the female version of "rube").

i am, once again, on call tomorrow night. i will log all the pages i get and share them in an effort to bring you closer to the experiencing the agonizing pain in which i spend every 4th night.