I am way overdue for a How Did That Happen? post yet again.
This week’s How Did That Happen? is all about surviving call. I did buddy call last weekend with our new first year resident (did I mention I love teaching?) and I have been briefing our other junior resident about what to do in certain situations and stuff like that. It had me thinking back to my first full weekend call as an R1 and my first gen surg call (shudder) and all that good stuff.
- Like anything else, show up and do your job. Seriously. I have met some mighty lazy people who just want to slack off or get others to do the work. Other people notice. It makes you look bad. It puts patients at risk. And if the other staff get wind of it, they can make your life pretty much miserable.
- Answer your pages. This goes along with doing your job. I mean answer your pages when you get them. Don’t make people wait if you can help it. Nurses notice if you’re being a jerk and not answering. They will also take pity on you when your pager stops receiving pages in the middle of the day and you failed to answer them the first two times they called (true story, my pager decided to konk out this weekend for about 4 hours… The fact that I am usually answer saved me from a ton of trouble).
- Trust your nurses and allied health professionals. They are my superheroes. A good nurse can tell when things are going south and give you tips and suggestions when you are new and unsure.
- If you are rounding on inpatients you don’t know, take the time to skim their chart and figure them and their current issues out, especially if they look unwell. It can save a world of touble.
- Before you leave after rounding, ask the floor staff if there is anything else you can do. Sometimes it creates work, but most of the time, it saves calls and it is the polite thing to do.
- Get handover. I’m serious. It is a huge safety issue. Even if people aren’t seeking you out to give it, check with the regular team if you can. If someone is unwell, find out what the regular team would want you to do in the likely scenarios. Ask for that plan. If they don’t know suggest something. Going in knowing what to do about certain expected issues can make life easier.
- Give handover. This is the safe and polite thing to do. Find the person coming on the next day and tell them either in writing or in person what happened to their patient, especially if it something that changes the plan.
- Know who you are on call with. If you are a resident, you will always have at least a staff person on with you. Often, a senior resident too. Know their name and number in case it is asked of you or you need to get in touch with them.
- Keep notes. Notes about the patients you need to give handover on, notes about things like outside calls. All that good stuff.
- Ask for help. There are situations that you just can’t handle on your own. Or you aren’t sure of yourself. Do the best you can, but ask for help. Try to know what your plan might be, but admitting you don’t know or trying to figure something out is good learning and much safer.
- If someone offers to lend a hand, take it. Sometimes, I had more senior residents tell me to text them if something weird came up that I just wanted to run by them. I was immensely grateful to just bounce a plan past someone without having to always run to the staff, especially when it was something simple that I was just new at.
- Sleep/eat when you can. I feel like I say this often. But, I have been burned many times by staying up to wait for that last call or waiting to eat at a certain time. Just do it.
- Some nights just suck. You can’t do anything about it. Just count down until it is over.
- Bad stuff will happen on your watch. Someone will die (both expectedly and unexpectedly). Someone will get worse. Something crazy will happen (like a piece of suture hanging out of a drain that nobody can explain). Someone will hate you (because you told them they needed something they didn’t want). Someone may come at you with a weapon (people get creative sometimes). Someone (including yourself) will make you look stupid (for instance, no matter how many times you tell a certain nurse not to do chest compressions because the person has a pulse and you need to manage their airway because they aren’t breathing, if the code team arrives and that nurse is still doing chest compressions despite your repeated attempts to tell her to stop while you are trying to ventilate because she just wouldn’t listen, they will still think you are the fool because you were “in charge” and it wasn’t even your patient, you just happened to be down the hall and arrived on the scene a minute before to help) know that. Learn from it.
- Sometimes, you just have to go curl up in a ball and cry because the badness is just too much. Other times, you have to beat the pulp out of a pillow. And at times, you will need to leave a room to laugh your face off.
- That paniced feeling of not having a clue what you are doing subsides. I don’t know when it goes away. I’m not there yet. It still comes in waves.
- Have good references on hand. Don’t be afraid to look stuff up.
- Prioritize your time. There are times where you are pulled in a million directions. Know what needs to get done. The sickest people are your priority. Computers and phones make good friends to help with reviewing results and doing quick orders.
- Document stuff. Because, as above, bad stuff will happen on your watch. So does good stuff. The medical record is important, both for patient care and legal purposes. Plus, the day team will appreciate knowing what all went down.
- If you are sick when you start call, odds are you will be sicker when it is over. One night, the nurses on a certain unit found it both sad and humorous that over the course of the night, my voice disappeared and my cough/breathing progressively got worse than half the patients I was managing. The whole illness being worse at night is amplified if you don’t sleep.
- If you do home call, don’t forget things like your stethoscope. Nothing is worse than carrying your tired body back to the hospital at 3am only to realize you have to use one of the crummy “fisher-price” stethoscopes because yours is in your other bag.
- If something can wait until morning for the regular team to take care of it, then let it wait. They might have a plan you weren’t aware of.
- If you feel annoyed at that 2am call for Tylenol or a sleeping pill, just be glad it isn’t a new onset fever in a chemo patient or wound dehiscence.
- Hospitals often have mice or rats. They come out when normal people are sleeping. Brace yourself.
- There is a rule when it comes to call… If you have big plans the next day, stuff to get done, etc. it will be busy. That being said, always bring something to do if you have down time. But, know it will likely be interrupted.
- Phone chargers and tooth brushes make the stay in hospital much better. So does take-out!
What are some of your surviving call tips?