Saturday, November 27, 2010

scenes from a marriage



When you are on home call--that is to say, call wherein you are carrying a pager (or in my case, two cell phones--one is a backup in case AT&T's notoriously patchy service drops a call on my iPhone) but not necessarily physically in the hospital, all you can think about is that your phone could ring at any time. AT ANY TIME. At any moment, you could get a call from the nursing supervisor telling you to get into the hospital now, there's some old guy with an aortic dissection, or some lady with a small bowel obstruction, or some kid with appendicitis who needs to go to the OR, so get your ass back here in the next twenty minutes.

I'm sure after a couple more decades of taking home call, I'll be inured to the catecholamine surge that accompanies every phone call, every text message, every twinge that indicates that someone somewhere might be trying to reach me, but...I'm not at that point yet. I'm just being totally honest with you: carrying a pager at home stresses me out more than carrying a pager at work. It just feels like the stakes are higher, or more invasive, like the hospital is bleeding into your home somehow. And having been on the receiving end of some pretty bad call weekends, I am admittedly a little bit...sensitive about things.

Now, these are some things not to say to someone who is on call:

"So...are you going to get called in?"

"You're probably not going to get called in, right?"

"Can I run to the supermarket real fast and leave you with the kids? What? Why not?"

"You're probably safe now, right? I mean, what are the odds you're going to get called in now?"

"What do you mean you're backup call overnight? But just backup, right? They won't need you, right? I mean, what are the odds?"

"WHY ARE YOU SO ANNOYED AT ME?"

This is why Joe and I are having a little time-out right now.

30 comments:

  1. As a sysadmin, one of my backup plans includes taking the baby with me to attend to whatever. Baby finds the noisy machine room reasonably soothing, but dislikes nighttime car rides rather intensely.

    I bet you have better ability, but less motivation to make the pager beep a few times, then ditch the kids and spend the evening at the public library.

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  2. Hey, I'm not saying I didn't fake-page myself out of several unpleasant situations during residency. Because I TOTALLY DID.

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  3. The amount of jinxing going on up there is freaking ME out! I have to take phone call for a week at a time, and I don't even like that even though I don't have to go in.

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  4. Oh man, just thinking about being on call at home is enough to make me anxious, and I'm not even in med school yet. :P I thought your home was your own space? Is no where sacred anymore!?

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  5. Elaine11:00 PM

    Hey, it's not just doctors! If you're a journalist, at any time of the day or night some major news could happen. In fact,in some ways being a journo is worse, because there isn't "on call" -- if something happens, no matter what might be going on in your life, AT ANY TIME you may have to deal with it. And if you live in a country with a lot of earthquakes, stuff often does happen. Seems to always happen on weekends or at weird hours of the night, too.

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  6. Anonymous12:54 AM

    The question my husband asks that I can't stand when I get called in from home:

    "How long do you think you'll be?"

    Somehow I cannot get across the uncertainty of ER or OB call. Who knows how long any one thing will take? Or if something else will happen in the meantime? It's a total crapshoot! Don't ask me when I'll be done! I have no clue!

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  7. Anonymous6:10 AM

    Nothing like going for a run with an ipod strapped to your arm, a phone in one hand and a pager in another...

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  8. Anonymous7:43 AM

    hahaha, Elaine, did you just compare being a journalist having to cover an earthquake to being an on-call physician (and insinuate that it may be "worse" to be a journalist?!) While I am sure it is stressful for you to worry about when the next big one is gonna hit, and what words you'll use to write about it, it is nothing compared to dealing with life and death situations when YOU are the person who could very literally save (or not, as the case may be) someone from death.

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  9. Hey Anonymous @ 7:43am, I totally see Elaine's point. At least for doctors, "on call" periods are mostly demarcated and the location of where to go when called in is consistent and stable (even if the patient or...ahem, the surgeon...isn't). I don't envy you that responsibility at all, Elaine!

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  10. Hahaha....your hubby is a doc and should know better! My hubby is a computer guy...and asks the same sort of questions for 72hr straight, one weekend a month (q4 OB call).

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  11. sarahMTSBB12:32 PM

    i'm a med tech and recently quit a job b/c of call. not being able to do anything from saturday 0730 to monday 0400 was the pitts! i had such bad luck that i'd even get called in for a direct admit when the hospital (small ortho that doesn't do surgery on the weekends) didn't even have patients left (very rare)... and the best part was that i was paid $1/hr to be leashed to the hospital. ugh. good luck! i don't envy pager carriers at all!

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  12. Anonymous2:57 PM

    OMG Why is Joe SAYING those things! Has he never heard of the Jinx? Does he know the cosmos LISTEN to these things? I'm on home call myself and broke out in hives and got nauseated reading this post. Crossing my fingers for both of us.

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  13. shelly3:21 PM

    No matter how long you take call it never gets better. I just dropped the hubbo at the horspistol for an exploratory lap (we were out shopping-go figure) I didn't ask when to pick him up, or how long it would take or god forbid use the "Q" word, as in "I hope you have a quiet day". Also after 28 years of a dual medical marriage medical time is "multiply by 2 and add thirty minutes. The nice part is that now that the kids are grown instead of staggering our calls so someone is always home, we arrange our calls for the same weekends.

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  14. I've been on call the whole holiday weekend and if I have to hear "Did you get called in?" from a relative ONE MORE TIME I may punch them in the nose! It's Rheum home call so a lot of refill calls, my arthritis is flaring what should I do calls. But I did have a few hospital consults. Thankfully I used your post to convince my sister in law to limit the comments!

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  15. Anonymous8:20 PM

    I hated home call so much, it's actually one of the reasons that I chose to specialize in Neonatology. I could not stand having the pager go off at home--it would sit on the coffee table and I would eye it suspiciously, like it was a ticking time bomb. And my husband hated that even though I was "home," I could not do anything fun (watch a movie, go shopping, etc.). So we both decided that in-house call was the way to go for me...when I'm in the hospital I don't have to think about the kids (thanks to my wonderful husband), and when I'm home, my time is my own.

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  16. Aussie Michelle5:57 AM

    Gah - the amount of jinx there is giving me hives!

    Elaine - not quite the same thing! There is a difference in being called on to observe, and being called on to actually do something about the situation and take responsibility for the outcome - and if there is an earthquake, or as more often happens here, a bushfire, where do you think the "off duty" doctors, ambos, nurses, firefighters, police are?

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  17. I'm not sure the activity matters much -- the stress is from not knowing what's going to happen.

    I did a lot of 24 call as an EMT before med school, and it did get a little better with practice. I came to view it as an opportunity for mindfulness training; anything might happen in the future, but I need only be concerned for the present.

    Family members are hard, though. I have a non medical spouse . . . I'm surprised it's not better with a fellow doctor.

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  18. The way I did it was to make a plan for the specific time period. If I was on backup and wanted to travel 30 minutes away for 3 hours I would call first call and see what was happening and what was coming up. If there were 3 hips and a bowel case on the schedule I would be inclined to NOT travel since the AAA or stat C section could arise at any time. If there was a hip on 3 hours in the future and things were otherwise quiet I would go since many of the cases we do are essentially electively urgent and if the first guy got busy the hip could wait 15 minutes till I got there. You are now an attending and deserve to be treated as such

    First rule of medicine take your own pulse. They trained this kind of fear into you in residency now its time to train it out of yourself. Be responsible but do not be hyper-responsible. See how your colleagues handle this i.e what is the corporate culture regarding this. Private practice is nothing like residency. Its all at once easier and harder. There is no one to pick up the slack. Your husband needs to understand this PERIOD. Also understand you are but part of the medical care team. A lot hinges on you but not everything. One thing to remember is some people go to the hospital to die, and die they will no matter what we try to do to save them. I had a 22 year old mother with twins that had an epidural. I was sleeping 10 feet away. During the delivery she flipped a pulmonary saddle embolism and that was that. The babies lived, everybody got sued but the bottom line is there is no way to save a delivering mother who flips a saddle embolism. You can't even crash onto pump and save her. The heparin would bleed her out. You take your lumps feel bad and go on.

    Also you can do a lot of triage on the phone on your way in. Make the head nurse fill you in on the case if she doesn't know then she needs to find out. You can then start marshaling your forces from the road Do you need blood? How many IV's does the patient have and what kind? If you need 2 big bores then demand those are ready when you get there etc etc You know how to do this, and you are going to be doing it for the next 25 years. How easy this is will be a function of how you make the environment. If you are reactive in your approach you will live in this kind of sympathetic soup if you are proactive you will know you have done what you can do to make things go smoothly, you will know you are good and your colleagues will get that you are good because you make the right things happen

    Be Kind There is no room for drama on the phone or in the OR when it hits the fan Be focused the notion the head nurse knows something has been trained into you. Typically she doesn't know shit so you have to direct her to make your reality optimum for the patient's benefit Direct her in a kind and focused way.

    Finally be good at what you do. No problem there, if you weren't good you wouldn't be worried about this kind of stuff. Look at how your colleagues do their jobs and pick the things that you see as effective improve them if you can and incorporate them into your practice.

    take heart I'm at the end of my career. I have done 20K anesthetics and 20K pain procedures and I have made a difference in many lives. In the end that is what this is all about.

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  19. The way you reduce the sympathetic soup is to become proactive instead of reactive Don't just sit there and stew but if you want to do something find out if its possible If you're second find out if first is busy, if he is your screwed, if he is not discuss with him your situation.

    Learn how to triage from the road. You don't have to be at the hospital to start things rolling in the right direction. You are attending, make the nurses work for you Get blood ready Start IV's etc Find out about the pt from the road and start to make your plan on the way in and list your priorities to yourself You know how these things go and you don't need to be present for the whole act to effectively direct the scene.

    Be responsible do not be hyper-responsible. This kind of fear was trained into you in residency, it's now time to train it out of yourself. Most "emergencies" are not really emergent and often grow out of someones "need" to control the outcome to his/her benefit As you grow more comfortable in your skin and confident in your skills this stuff will get better. Learn from your colleagues. See what they do and how they manage, and incorporate an improve on what they do in your life

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  20. elizabeth8:59 PM

    I haven't taken any call where I could get called in to the hospital in 3 yrs and haven't even carried a pager in over a year, but I still get the catecholamine surge every time my husband's pager goes off.

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  21. Aussie Michelle8:48 AM

    On that note, I used to have a (non medical) housemate who had an alarm clock which was just audible from my room and sounded very similar to the arrest code on my pager (and from that distance, eerily similar to pager buried under pile of clothes). Once boyfriend and I were both half out of bed to run to the arrest before we both woke up properly.

    I was tempted to make it have an accident, but in the end problem was solved with an awesome Christmas present of ipod dock - smiles all round!

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  22. The obverse to this is my mother's situation. She's an LPN who gets Baylor at a rural hospital where they're trying to do away with that pay scheme. She frequently finds herself on call. We try the jinxes often to do our part so that she gets called in. Paychecks are good, after all.

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  23. Oh, that made me shudder. Not dissimilar to my mother over Thanksgiving - I had home call (which for us on holiday means going in OR annoying mommy/sick calls, plus inpatient rounds) from 0700 Thurs to 0700 Monday, and for the first 2 days, EVERY TIME my pager would go off, my mom would say, "OH NO!". I finally had to talk to her about NOT SAYING THAT. For the love, the beeping is bad enough!!

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  24. Anonymous12:33 AM

    I am an anesthesiologist and intensivist. I had the hospital operator forward all calls to my iPhone. Somehow, having a gentle "bing" instead of a beeper defused a lot for me.

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  25. Same thing happens when you're a pilot on "reserve". At my particular airline, I had to be within 2 hours of the airport. That is to say, the plane needed to leave the gate 2 hours after the call came in. I was in New York, where you NEVER know what traffic is going to be like. I was pretty much tethered to my house, because I was petrified of going out without my flight bag and overnight bags. Even if I went for a run, I would stay within a 5 minute radius. It made for a lot of repetition!

    I did this five days in a row, from 0400 to 1800 (usually). Then, I would have 2 days off and commence this schedule again (and again, and again). I'm surprised I didn't croak from high blood pressure!

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