Sit Down, Get Paged, Repeat

From the December 23, 2022 issue of the Transformational Times 

 

Sit Down, Get Paged, Repeat

 

By Laura Slykhouse, MD

 

At this time of year, we celebrate and thank our hard-working residents and hospital staff that work through the nights, weekends, and holidays. Dr. Slykhouse, a resident in Internal Medicine, recounts a call night that was also her birthday. She shares some moments which are specific to being in the hospital overnight… 

 

Birthdays have a way of getting less and less exciting each year. Yes, there are some milestone birthdays we celebrate as we get older; but, as the years march on, enthusiasm lacks compared to a sweet sixteenth or a twenty-first birthday. This year, I see my schedule for June and of course, I’ll be celebrating my birthday at Froedtert at the end of a twenty-eight-hour shift. 

I readjust my expectations and wish for a calm night, good cross-cover, no ICU transfers, and friends to make the time go faster. The night is off to a good start when my favorite co-resident is pulled in to cover the night portion of the shift with me. I was obviously more excited than she was, but the night was looking promising.  

We get sign-out, nothing exciting. Then we start brainstorming our evening – what kind of food are we going to order, which movies do we hope to watch in the team room and what music should we listen to. We’re not even five minutes into our planning when two pages come through – it’s the admitting medical officer (AMO) with two outside hospital transfers who are already on the floor: one with metastatic lesions to the brain and concern for increased intracranial pressure, the other one for AMS (altered mental status) in an elderly woman. This would be the last quiet moment of the evening.  

We decide to see the patient with concern for increased intracranial pressure first. He does not appear as sick as his labs and imaging have detailed. This is one of those times in residency where I feel the sense that a patient could decompensate quickly, but next steps are not clear. I feel uneasy about this patient. We call the neurosurgical team, and they also share our concerns and take over care of the patient in the Neuro ICU. The patient and his wife are very grateful for our small contribution to his care.  

Then the cross-cover begins. Two stroke calls, status epilepticus, a transfer to the Neuro ICU and Medical ICU. This is not the night I had planned when the shift started. However, time is passing quickly as we try to triage the patients and deal with one situation at a time.  

It’s now midnight, and I’m happy there are still a few options left on Door Dash, as I have been craving Mexican food the whole night. This would not be a night for a movie. The chaos continues throughout the night, page after page, almost comical with the timing – sit down, page, sit down, page. The food delivery has been there for hours, but something about a lukewarm burrito at 4:00 AM is less appetizing.  

The last crisis of the night is the elderly woman admitted for AMS. She has dementia and hypercalcemia. We give IV calcitonin and a bisphosphonate which causes diffuse body aches. She speaks both German and English intermittently. I find myself drawn to her. I’m not sure if it’s because she reminds me of my grandma or because I feel guilty that our treatment has caused her pain. I hold her hand for a while, and she seems to feel some relief from the IV pain medication. Just this small point of contact makes the night seem less frenetic. It reminds me why I enjoy what I’m doing, even during the difficult nights, the missed holidays and celebrations.  

It’s 6:00 AM and we re-group in the team room. The window for sleeping has passed, and it’s evident I’ll need a significant amount of coffee to make it through rounds. We debrief quickly, cold burritos are half-eaten and abandoned next to the computers, and I feel proud. I learned a lot, we gave the best care that we could, and another call shift is over.  

 

Laura Slykhouse, MD, is a PGY3 Internal Medicine resident at MCW who is planning to start her career in hospital medicine.