Call Week
It's the second night of my 7 day call week.
There was a time, when I first started, when we took call one day a week (my day was Wednesday, if I remember), and then rotated call with my partners through the weekends (Friday - Sunday).
Back then, no question, we were busier. If memory serves me correctly, the pager went off most of the day. I was still admitting people to the hospital, even seeing them in the ER. If they were in the ER and needed admitting, I went to the hospital and got them "upstairs", orders written, chart notes written AND dictated. And I followed them through the hospital stay, and discharged them home at the end. And the babies - I was still delivering babies then, too. It didn't matter if I was on call or not for the babies; if it was time for mom (and baby), it was time for me, too. With an ER admission, even if I had to crawl out of bed at 2:00 AM, I could generally count on being able to crawl back INTO bed between 4-4:30 AM. I'd get my patient "tucked in", and I could go home. With the babies, I was up for good; I would not see my bed again. In fact, I would hope to be done in time to arrive, bleary-eyed and rumpled, for my first patient of the morning. But the trade-off in time was made up for in, generally, joy. To this day there is nothing so miraculous in medicine to me than to be there at the birth of a child - to transition a life from the warm, dark intra-uterine world into the bright, noisy, chaotic love-and-touch-filled extra-uterine one.
Little-by-little, though, my time transitioned to more and more "outpatient" and less and less "inpatient". First, I stopped delivering babies. I was the last of my practice to do so, holding out for as long as I could. But the risks and economics of obstetrics changed through forces beyond my control and I eventually had to just stop. I did not miss the sleepless nights and the stress-filled deliveries - hours spent at the nurses station, watching fetal monitoring strips of "stressed" babies, misbehaving enough to need constant vigilance, but healthy enough to not "call the section". But I do miss the OB visits and "uneventful" deliveries (there's an oxymoron for you). I miss the office OB visits: the happy couples, the waxing fundal heights, cm by cm, month by month. I miss placing the ultrasound on the tummy and watching the faces in the room as we all listened to the fetal heart beat - whoosh-whoosh-whoosh-whoosh-whoosh. Next came the hospitalists, which freed me from taking care of my patients in the hospital. This was a blessed relief, as the increasingly complex and procedurally unique world of inpatient medicine was taken off our duty list. At first it was weird for both patients and me to "hand off" to another doctor during their hospital stay, but it soon became clear that they were going to get better care, and everyone was good with it. Finally, we stopped seeing "high-risk" newborns. That eliminated the middle-of-the-night calls to rush to the birthing center to resuscitate a baby in distress, or to be present in the OR for a C-section for anything but routine reasons. This change, finally, meant that I could be on call and not have to be within 30 minutes of a hospital. For a doctor who spends about 15-20% of his work life on call, this was huge.
So these days the only trips to the hospital on-call are for low risk newborns. Our call years ago moved from one day a week with rotating weekends to rotating 7 day weeks all at one time. This was a good move overall. It meant vacations could be planned for weeks when I wasn't on call, and I didn't have to arrange coverage EVERY time I wanted to be away over a Wednesday. And so it's been for the past several years. The weeks can get a little long. But at the end, I can hand off the pager and not have to think about being on call again for generally at least 2-4 weeks.
I wish I could say that the time given back in terms of ER visits, hospital admissions, delivering babies, and attending high-risk deliveries was able to be used instead on time with family, or sleep. Some small part of it was, to be sure. But the rest has, unfortunately, morphed into the increasing amount of time we doctors are required to spend in front of screens (which is a whole other blog topic).
Call is unquestionably less of a burden these days. But it is still a burden. It is still the pager that cannot leave your side for a week, buzzing at any time day or night. It can be sleep, quiet time with my wife, a car ride with my kids, sitting in church, or trying to go for a run when I will get the sudden interruption to stop whatever I'm doing to attend to whoever is calling. It is not a big trauma by any means, but it is a hundred little ones. So much so that when a pager goes off on a TV show I instantly feel my heart drop and my pulse quicken. So much so that typically during the first couple days OFF call, I will momentarily panic when I touch my R waist and don't feel the pager there. I have horrible insomnia, and I am convinced call is to blame. Decades of nights where I've been abruptly awoken to rush to the hospital to attend to a baby in distress, or helping an anxious mom with a sick child, or (even worse) called for a trivial problem that could have waited, have left my brain primed for interruption and disturbances any time I try to sleep, not just the call nights. I don't (usually) begrudge the situations, or the people calling; that's the job I signed up for. And being able to help is personally and professionally satisfying. But it doesn't help me sleep any better.
The reason I mention all these things, is I now have a very finite number of call weeks left. After this current call week, after all the call I've taken for the past two decades, I will have 4 more weeks of West Hills Health Care Clinic call remaining. To me, that seems like very very few.
I don't know exactly what the call will be like when I'm in New Zealand, but I do know that the worst will be very far behind me. I'm thankful for that. I'm sad, in a twisted Stockholm Syndrome sort of way as well - mostly for the "ending of an era" type of thing, I guess. But mostly, it's just one more way to measure the rather profound changes that are coming very soon, and one more cause to reflect on all (good and bad) that's come before.