You might remember that we lost an intern colleague in South Africa a while ago, when she was in a fatal car accident after a long overnight shift. It was a big accident involving other vehicles, with at least two other people requiring ICU care.
One of them recently succumbed to her injuries, and the victim’s family members have made it known that they intend to sue* the Department of Health.
Most of my colleagues seem very happy with this. The government must be held responsible for the consequences of working their young doctors to exhaustion.
The first time I partook in a baby’s resuscitation was during my fourth year of medical school. It was a disaster: the wall-suction malfunctioned, the nursing staff were in the precarious business of changing shifts, and all algorithms flew out of the window.
I vowed optimistically that when I was a doctor, I would not let a baby die that way.
I had a lot of criticisms, which is so easy for a student to do; but I did learn from it. I learned to prepare myself mentally for any scenario where a life may need to be saved, so that I could give that life a fighting chance.
Last night it was my turn. I was called to the ward for a desaturating baby with pneumocystis carinii pneumonia (PCP). It was my call to start bag-mask ventilation, and then to start compressions when his heart rate dropped below 60.
I participated for the past two years and performed – well, kind of dismally. I could go on to diss the event for being unrealistic, but I know a lot of people write well during NaNo. Well, it isn’t for me. I do so want to finish one of my works in progress, but it’s not going to happen in a month, and most certainly not a November month.
… and none of that pseudo-philosophical “you have to pace yourself” bullshit.
I mean, I’ve never even run a marathon. But I’m training for one. My training plan was too ambitious though so I think I have shin splints (why does medical school not teach us about shin splints? Am I imaging them?) so combined with my grueling call of last night, I’ve had to forfeit my long run for this weekend.
Being on-call is like running a marathon (or a long run, or any run; depending on how fit I’m feeling) because:
When I’ve had a really rough night on call, the only way I can get myself home in one piece is to play the music in my car really, REALLY loudly. I can get a bit raucous. Yesterday as I was driving home after one such call, P!nk’s Walk of Shame came on my shuffle.
Today I’ve been working for three months. It’s almost hard to believe. My first rotation is almost over, and my next rotation will be anaesthesiology (they just won’t let up, will they?).
My first call of Internship was on a Sunday. I was so nervous that I had an upset tummy that morning (but not upset enough to call in sick). It was terrifying and exhilarating. I had a big breakfast – perks of living at home!
I wasn’t even halfway to hospital when my phone rang. We don’t have pagers, we just have speed-dials so we are reached directly via cell phone. I thought maybe the medical officer was calling to shout at me for being late, but I was not actually late YET.
Wow. I was on call on Friday (24+ hours) and it was INSANE. I did not sleep once and spent probably three-quarters of the night in theater. One emergency C-section after another, a handful of ectopic pregnancies – and a team of two: one medical officer and one intern (that’s me).
However, this was probably THE most incredible surgical-time I have ever spent on call. The medical officer I worked with was so experienced in Obstetrics and Gynaecology. I have never seen someone do a C-section or a salpingectomy so speedily – and she is not even close to finishing her training in OBGYN yet.
I’m writing to ask you please to not do that thing.
You know what I’m talking about.
It’s a Saturday morning, or the middle of the night on an overnight call, or whatever: it is a time of day that nobody wants to be working. And we are working. Maybe we are working on the same service, maybe I don’t know you from a bar of soap.
I am sitting in the doctors’ room writing notes for the latest patient that arrived in our care. You come in and sit next to me, looking for results on the computer or making notes for your own patient or maybe just drinking a coffee.
You see the design of my name badge so you know that if everything goes well, I will graduate by the end of the year and be one of your colleagues.
Then: you let out a long sigh and say loudly, “You know, it’s not too late to walk away and change your career.”
My school doesn’t allow students to be on duty for more than 24 hours at a time. The few times that a doctor has expected me to stay beyond 24 hours, I have always pointed out the rule and if they disregarded it, reported it. Because, seriously.
But for some reason, we have one week in Internal Medicine with Cardiology, where we are expected to work 36-hour shifts and somehow, despite many students having complained about it, it is allowed. This time I didn’t go on a “crusade” about it, because honestly I am just so tired of constantly being on a crusade.
It was a rough night on Internal Medicine call yesterday. Medical Emergencies was overflowing. At one point, we had thirty patients in the passage, because the beds were full. We had more patients requiring ventilation than we had ventilators. It was chaos.