call notes / taking a deep breath

October 29, 2016

I’m on call this weekend.  There are 52 weekends in a year (well, actually 52.5 this year + next year! Neither 365 nor 366 are evenly divisible by 7).  I am on call for 10 to 11 of them.  

Therefore, call is a part of life.  Not a huge part, but a sizeable chunk.  It’s not disposable or insignificant.  And the truth is that it’s not even that stressful when I’m doing it!  I’m not stuck in the hospital.  I am not (usually) woken up multiple times throughout the night.  I do have to round, write notes, see a handful of patients, and answer emergency phone calls.  On a more strenuous day, I can still typically finish rounding by early afternoon.
It sounds fairly reasonable, doesn’t it?  That’s because IT IS.  I know that physicians love to be martyrs.  And many of them are working very high volume hours with a huge amount of stress during those hours.  Josh, for example, was at the hospital until 3 am last night.
I was on call, but slept peacefully until my alarm woke me up — not a patient (or a kid, for that matter).
I am still a ‘real’ doctor.  I care about my patients very much.  I try my very best while I am at work. But I do tend to compartmentalize and shut off my ‘work brain’ after 5 pm most days.  Truth:  I have no desire to work long hours.  I chose my specialty and my work situation very deliberately.  There is nothing martyr-like about my life.  I want to have kid time, family time, me time, workout time.  I want to manage our household and be home for dinner with the kids.  And I really actually can say that I LOVE my balance* most of the time.  Except when on call, when I become stressed out for no real reason at all.  I think it’s a control issue — I can’t set the schedule or know when an urgent consult might come in.  I tend to get very ornery with Josh, eat total crap (somehow I feel like I’m “allowed” on call — holdover from residency??), and have a strong urge to just scrolllllllllll mindlessly until the time passes.  To numb my anxiety and pass the time?  I suppose.
But I have GOT to learn to get past this stress.  I may very well have hundreds of call weekends ahead of me.  This weekend has been a pleasant mix of home+work life thus far, and there is no reason it won’t continue to be.  I mapped out a plan for the weekend and so far it is falling into place.  I am cozy in my new office, done with patient notes and writing this post.  I am about to go home to the kids.  Life is good.  
Here’s to taking a deep breath every time my phone rings and accepting call as a normal part of life, not one to be hated/endured/gotten through.  Someday I believe I will get there!
* Or mix, or mosaic, or matrix, or whatever you want to call it; apparently the word ‘balance’ has fallen out of favor



  • Reply beth March 10, 2019 at 7:10 pm

    I’m on call at night and about 8 weekends a year for our nutrition support service (I’m a dietitian, not a physician). Usually that translates to someone might phone me in the evening or early AM a couple times a week regarding our TPN patients, and then on the weekends I’m doing whatever nutrition support patients we have and new nutrition consults (education, nursing screens, consults, whatever). It’s usually a busy two days, but not unmanageable in most cases. Usually I see like 18-22 people each day whereas a normal weekday would be like 15.

    I find myself in the same predicament of really dreading my weekends just because it feels – it is – like every little thing that happens is going to be my problem from about 4pm Friday until 8am Monday and it’s a black cloud hanging over me. For my job, that might mean a physician is giving me grief about patient labs (depending on the person, a minor annoyance or occasionally stressful), a ped comes in with EOE that needs a gluten free, potato free, soy free, dairy free diet, a DKA patient is literally throwing their meal trays at staff unless the dietitian approves for them to have 3 sausage biscuits, 2 bowls of grits, and a bagel for breakfast (this is actually based on a true story and the diet order was longer, but I can’t remember what else they wanted…and somehow this patient had my direct phone number), and then just your garden variety ill folk.

    I try to just tell myself it’s not going to be any different by being stressed about it and try to make myself stop and drink a coffee, eat lunch, etc whereas I used to just try to speed through in the hopes of being done early. Nothing that is actually different from my day to day happens on the weekend, it’s just usually amplified a bit. Anyway, not the exact same as your situation, but all of that is just to say that I get a little of why you feel this way! It sounds like you are handling it pretty well.

  • Reply delia March 10, 2019 at 7:10 pm

    I’m just a year or two out of training, so I’m still positive about call now compared to then. As an attending, I only have home call 1:9. To me, even the worst home call is better than 30 hour in-house call as an internal medicine resident! Nowadays, I generally have an "it is what it is" attitude about things I’m not too fond of, and I’m generally pretty happy. I’m on call next week though, so we’ll see how that goes!

    I can imagine balancing family and work makes call a bit more unpalatable. You’ll get through it! I hope you have a great weekend!

  • Reply Jenna March 10, 2019 at 7:10 pm

    this is like an on-call support thread!

    I do weekend call as a transplant donor coordinator [think: red cooler with organs in it and waking up surgeons in the middle of the night] – and for me I know that means there are exactly 64 hours of on-call on a standard weekend, 88 hours on a long weekend!

    I love what I do. But I’ve always thought the "anticipation of work" during on-call is worse than the work. I adjust my lifestyle so much on these weekend – that when Monday rolls around I feel like I haven’t accomplished anything. Even though it is a simple things like the dog hasn’t gotten any really long walks, I haven’t been able to hit the trails for run, I don’t make firm plans with friends, etc. The things that would normally help me enter into a new week refreshed!

  • Reply Elaine March 10, 2019 at 7:10 pm

    I’m only a resident so all my after hours/ call work means I’m in the hospital but I empathise with that feeling of frustration when pager/phone goes off. I think for me a large part is the lack of control. When I’m managing my team patients I know them well, I know what their problems are and where we are up to in the plans. When I’m covering the ward patients outside hours I’m starting from nothing and have to piece together prrtty quickly what the team has been doing and what the pertinent issues are as well as hope my plans coincide with what the treating team was trying to do. I also get flustered when I’m in the middle of something (I.e inserting an IVC) and my pager is going off and I can’t do anything about it. If I knew when all the pagers were going to come and what to do I’d feel 100% more relaxed 😀 I hope your weekend ended up being ok!

  • Reply Ana March 10, 2019 at 7:10 pm

    Oh man, obviously I so get this. And I start a week of call Friday night so I’ve been thinking about it. The weekends are really awful in anticipation for me because I have no idea until I get sign out Friday evening whether I may be done by mid-day vs. rounding for 8-10 hours. So no weekend plans at all. We start early on weekend mornings so its all I can do to take the dog out for a quick walk before I need to be in the hospital so I don’t get exercise.
    Its also a constant state of anxiety in the background because ANYTHING could happen and i"m in charge. So I never feel fully relaxed. I don’t know the answer to "liking call more" or at least "not hating call so much". I think its impossible to not dread/dislike it, but I try to also remember that there is still time in the day for small moments with my kids or myself to enjoy. And the truth is, I don’t mind the WORK itself. I know that what I’m doing matters and is helpful for patients/families/other doctors. I try to focus on that. Maybe i’m not super happy for that week/weekend but I am making a difference, and that may have to be enough.

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