* * Anonymous Doc: So close, yet so far

Saturday, June 9, 2012

So close, yet so far

How can three weeks seem so close and yet so far away?

You would think that knowing there are only three weeks left would make it easy to handle anything and everything.  Long night?  So what, it's only three more weeks!  Six admissions at the same time?  Who cares, I'm done soon!  Nurse who won't do anything, intern who spends four hours writing one note, attending who yells at us for sport?  What's the difference, I never have to come back here again!

And yet... and yet the power of sleep deprivation is strong enough to destroy rational perspective and make it seem just as terrible as it would seem if I were just starting.  Working overnight is awful.  It's lonely, it's draining, and it's terrible for the patients because at 4AM, I don't know what I'm doing.  I stand there, in the patient's room, staring at the monitor and forgetting what the numbers mean.  I look at medication dosages and find myself utterly unable to do simple math when I haven't slept in a day-- and haven't slept well in two weeks, because the body is not meant to keep switching between days, nights, and 27-hour overnights.  Does he get 10 mg, or 100 mg?  The difference is meaningful-- at one dose, he gets better; at the other, he doesn't, or even worse.  But I find myself double, triple, quadruple checking, because I just don't trust myself.  And there's no one to ask for help.  I can't wake up a fellow at home at 4AM to ask if I'm dividing right.  Or to help me draw blood, because my hands are shaking because I'm running on some combination of desperate adrenaline, three sips of Coke that I forced myself to drink, and the fear that someone's not going to make it through the night because they're stuck with a resident who isn't designed for sleeplessness.

They justify long hours because they want to minimize handoffs.  But a handoff is pretty useless when the person handing off the patient can't think straight.  My signouts are pretty terrible in the morning after an overnight shift.  "Jones is still alive, yeah.  Check his labs, I guess.  I think I checked his labs a few hours ago.  Might have been a few days ago.  Might not have been Jones.  Wait, Jones was discharged yesterday.  I mean Johnson.  His labs, yeah.  I think I ordered them every two hours.  I meant to.  Maybe I dreamed it.  Anyway, he should have labs, and you should check them.  Unless I'm dreaming his entire existence.  We transferred Jackson to the ICU.  I meant to call his family, but all the numbers on the phone looked funny, so I didn't.  He woke me up to change the channel on his television, so I guess he's probably okay."

I promise, day shift signouts are much better.  Try not to be in a hospital overnight.  Try to stay out of hospitals generally.  Or bring your own doctor.  Yeah, that's it-- hire a doctor-- an awake doctor-- to watch over you all night, so that residents like me don't come in and try to give you 10x your medication dose, or take you for a test that they imagined you needed but were actually having a nightmare about during the 45 minutes they were able to curl up on a roach-infested couch and close their eyes.

I can't even remember the code to the call room sometimes.  It's 4:30 in the morning and I'm standing outside a call room, punching in numbers until I hit the right ones, because I don't know if it's 1666 or 6111 or 1116 or 6661 or 6161 or 1616 or there aren't even any ones or sixes in it at all.  Why do numbers get so hard in the night?


  1. You have just described call so unbelievably well. I wish so much that I only had three weeks left instead of a summer of CCU, wards, elective, ICU. Sigh.

  2. The problems with handoffs are how the old guard justifies pummeling the newbies with terrible hours and more complicated patients than they ever had to deal with. Oh yeah, and all that "learning" you do when you've been awake 36 hours straight.

    But what do I know, I'm just a med student.

  3. hang on there...you will be free in three weeks!!!

    after read this blog, i feel i should apologize to my resident for what i told him yesterday, i am so regret!!!

  4. Sounds like he's very afraid, but I have to say overnight calls are some of the most fun times 90% of the time.

  5. Comment a year later....

    I can't do numbers at night. But usually I have a calculator and some other human to double check the math. I've had arguments with nurses where they were telling me a totally different number and I was super confused (they were right every time, except in DKA).

    My problem was always staring at the bedside, deciding if I was watching a seizure, a behaviour, a twitching, painful myoclonus, or dreaming the whole thing up, and whether I should load with benzos, despite the ICU saying they have no beds. I've ended up just standing at the bedside, staring, unable to make a decision, and finally committing to something based on - what? Experience? Knowledge? Educated guess? Pointing my finger at a random drug in the book? I had no idea.

    I'm braver now. I HAVE experience and knowledge now (well... minimally, but more than back then). But I'm sure I'll still find myself standing, staring, spacing out, and being unable to make a decision.

    Yup. Night call.