Thursday, January 10, 2008

Boring Night on Call

So I read a book. It's a very interesting book, an autobiography written by a young British man with Asperger's syndrome and savant syndrome. I can highly recommend it. He actually sees the world in fields of numbers, only he experiences numbers in terms of textures and colors (he also has pronounced synesthesia). If you've ever thought you were in a minority, imagine this: being autistic (and yet quite intelligent), having epilepsy, AND being gay. I feel positively normal reading this.

...Aaaaaaaaand then, after seeing zero patients before going to bed, I woke up at 5:30 this morning to find that suddenly our team had two new floor patients to work up, two new newborns to work up, and two old babies to see. Before 8 am, when we are required to go to morning report. That's one thing about our pedi program that is bizarre: post-call, residents are required to go to morning report AND noon conference. I fell asleep during noon conference, which was a streamed video of a lecture on "sodium and water balance" and woke up at 1 pm to find I'd drooled all over myself. Awesome.

Now I'm watching "A Baby Story" on TLC (I totally cried during the last one, it's terrible) and trying to stay awake until bedtime tonight. Even when I sleep during call (and I'm not complaining about sleeping during call, trust me), it's just not the same as sleeping at home, and I'm really foggy and stupid for the rest of the day.

I'm finally understanding why the 80-hour rule (and the 36-hour rule, with no new patients after 24-hours) creates such a hassle for residents and programs and why some residents think this rule is a problem. Often, residents take call for one hospital and then spend the day at another or on another service; post-call, they are expected to show up to their other service, but are not technically allowed to care for new patients. The call schedule for the pedi program I'm working with right now is an amazingly intricate, complicated thing. I wonder if, in an attempt to gain meaningful and varied experiences for their residents, that some programs stretch themselves too thin and attempt to cover too many locations, necessitating that someone be on call at all these places.

While I'm all about putting limits on the # of hours that residents work, I can now understand a) how easy it can be for residents to go over 80 or 36 hours; b) why a resident may not want to leave at 36 hours (if there's work to do that won't get done till tomorrow) c) and how well-meaning programs might get in trouble, if residents are on a very busy service and truthfully report their hours (while the program is trying to fix things), while programs that are flagrantly abusing the 80-hour rule can get away with it because their residents do not truthfully report their hours for fear of punishment. It's much more complicated than I initially thought.

I guess it's time to do some post-call laundry now.

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