Almost at the halfway point

February 4, 2022

Call starts Tuesday morning, so halfway through the 168 hours of consecutive availability is Friday at 8 pm. That is downright depressing from this vantage point, but unfortunately that is the math.

I will say that weekends are usually not as stressful, because on those days, I do not have outpatients to fit in and the hospital is generally slightly quieter. I can use Sat/Sun to catch up and I will need it because this week has been demanding and I am behind on everything: patient notes, GME emails & issues, and the rest of life. Yesterday I arrived home at 7 pm and saw several mistakes on a kid’s math homework and just . . could not bring myself to address said mistakes with the kid. So I didn’t.

Josh was at work until late in part because he spent time dealing with some new house issues which are borderline catastrophic (we received a casual email from our insurance agent that they ‘didn’t notice’ things on our roof inspection — oops! — and that due to this oversight, our insurance will be cancelled if these things are not fixed in 3 weeks, and by the way no insurance = not meeting mortgage criteria so it’s not really optional. I cannot tell you how many curse words were uttered when this happened. I knew there was a reason I dislike homeownership).

Being on call highlights the relative balance and life satisfaction I DO have the rest of the time, which is good. And my current schedule only has me doing this ~6 weeks/year which really is not bad at all. But I am still dismayed at the thought that I am not even halfway through.

Here is how yesterday went:

Start the day tired (2 overnight calls and a patient I was worried about = terrible sleep. Patient ended up doing fine). Drag self out of bed at ~6:30 so no time for morning routine or energy for workout.

Leave home without eating breakfast, because I am late and not terribly hungry.

Interview 2 people (our division is hiring – which is good, but bad timing for the interview!) while feeling flustered + overwhelmed about the day ahead

Arrive at work; run around seeing patients. (Bright spot: I have a sweet + helpful resident!)

Run back and forth to hospital attempting to fit inpatient consults between outpatients. Receive EpicChat notifications (some urgent, some not) while seeing outpatients

Eat the following things from the hospital cafeteria throughout the day for lack of better options: pepperoni + cheese, graham crackers + peanut butter, completely stale and borderline disgusting bag of PopChips

Have a healthy venting session with 2 colleagues (I love my colleagues! Another bright spot)

Arrive home dehydrated, hungry, and many outpatient notes undone from the past 2 days

Ignore math homework mistakes, eat a dinner standing up, and put the kids to bed (8 pm)

Anxiously scroll, literally exhaust the internet of things to read online, answer one page, get 7.5 hours uninterrupted sleep (yay!).

(I did not scroll Instagram and haven’t since I quit in November. I actually almost feel like I have an aversion to that app now. So that’s . . . good, I guess.)

So yeah. I am truly unhappy while on call. Every time, I go in with good intentions and then it’s like literally . . . feeling like being beaten up and waiting for the torture to subside. If my job was like this all the time, I would figure out something else to do. But it’s not, so I need to . . . I don’t know, somehow figure out how to do this better. If that’s possible. I think it’s the friction/stress of feeling like I absolutely cannot do the kind of job I want to do, and knowing that the stakes are high. And add complete lack of control over the workload + unpredictability + sleep deprivation + the need to remain nice+patient through it all. It’s a recipe for misery. I also, notably, have zero bandwidth and zero patience for the kids while on call.

Today I will try to eat something that is unprocessed and avoid dehydration; I will also not ruminate on how behind I am because it is very likely I will be able to catch up over the weekend.

I am supposed to participate in a ‘work life balance’ panel at 12:15 today which . . . well. Maybe I’ll just stay quiet.

One more thing!

Here’s how, if I were in charge of the world, I would make call better:

1- Split it up. Tues 8 am to Friday at 5 pm would be one person, and then Friday at 5pm to Tuesday 8 am would be another. Yes, call would be more frequent. 168 hours of pure availability is too many in a row in my opinion.

2- Write out some clinical problem solving algorithms especially for diabetes and put them on our website. Have the paging switchboard people direct people to the algorithm first, and if questions remain unanswered then they can be connected with the on call physician.

3- Alternatively, have some kind of advanced practice practitioner or nursing/diabetes educator coverage to help with overnight calls. (This nurse perhaps be someone very part time who only works some nights and no days. It would not be a bad job – there would be a lot of sleep!). I would gladly pay for this out of my salary! Again, if there were questions we were needed for, we would help out. (In many academic institutions, fellows play this role, as I did when I was a fellow! But we don’t have fellows . . .).

This could also be a national service! Probably one shared nurse/CDE could cover multiple programs/locations. Business idea . . .

4- Clear call day schedules of outpatients to the extent possible.

There! I fixed it. Ha. Even just #1 would help. Maybe I need to lobby my colleagues . . .

One more bright spot! I ordered these and they came yesterday and they are SOOO comfortable. Totally wearing them to work today.

On Cloud “Cloud”


  • Reply Gillian February 4, 2022 at 7:23 am

    Your call set up sounds rough. If it makes you feel better, I never correct my kiddos’ homework. Their teacher should see (and should WANT to see) what their independent work looks like. All I do for my 8 and 6 yo is confirm their homework gets done. The middle schoolers are on their own. Let yourself off the hook for that one.

    • Reply Jenny February 4, 2022 at 8:42 am

      I was coming in to say this too. I actually feel like I’m doing my kids and their teacher a disservice if I correct homework because then their teacher cannot know what they are or are not graspng independently. I only confirm that it’s done and I don’t even look at it otherwise.

      • Reply Cara February 4, 2022 at 3:20 pm

        I agree. I would never correct the homework because then how would the teacher know what my kid can actually do/not do. I take it a step further and never remind or tell my kid to do homework. I think homework (especially in elementary) is nonsense and if the school want to do that then they need to be able to motivate my child to do it. For the record this often results in him not doing it and instead spends his time reading, playing and doing physical activities, which imo is a way more valuable use of time.

        • Reply Anandi February 8, 2022 at 1:33 pm

          Oh gosh, THIS. My older goes to a middle school that doesn’t believe in homework and it’s a beautiful thing. She is actually learning stuff 🙂 When choosing a school in November for the younger kid due to a bad fit, it came down to one with a ton of homework and one without any. I chose the latter and have NO REGRETS. I see the corrected work that comes home with my kid and know she’s doing plenty. Our lives are SO MUCH EASIER now.

  • Reply Maya February 4, 2022 at 7:29 am

    I’m not sure if you have your own practice or work for a corporate entity, but splitting up call and educator coverage seem like it should be possible… and it sounds like it would totally change the structure of call for you. Especially if you’re willing to pay for the educator! GME is so important, and I’m grateful you’re in it.

  • Reply Margaret February 4, 2022 at 7:52 am

    That sounds really tough! For the food issue, would it be possible that the week before call you shop for call food to keep in your office? You could have a case of bottled water, granola bars, trail mix, good chocolate, whatever you like. If you have access to a fridge, you could get a vegetable or fruit tray. That might make at least one aspect of the week a little better.

    • Reply Sarah Hart-Unger February 4, 2022 at 8:04 am

      I totally should OR I could also have done UberEats/DoorDash/etc and gotten something better. I was just running around and somehow didn’t feel like I ‘had time’ to even order/meet a delivery person which is . . .probably not true, but it felt like that.

      • Reply maxine k February 5, 2022 at 8:24 am

        I feel like this a lot! Sometimes it feels like a lot of work to go through the ordering process for takeout when already overwhelmed with other stuff. One minor point in your post, but…yeah. Your ideas re: diabetes educator are good. Any way to bring a fellowship program to your institution?

        • Reply Sarah Hart-Unger February 5, 2022 at 8:54 am

          I WISH! unfortunately peds endo is an unpopular specialty and there are many spots going unfilled every year. programs are shutting down. we’d never fill. and probably wouldn’t get approved anyway, since existing/established programs are not filling 🙁

          (why is peds endo unpopular? well, it’s a poorly paid specialty and you just heard how call is, so . . . maybe they are right.)

          • omdg February 6, 2022 at 1:06 pm

            I suspect it has to do with the poor reimbursement, and the lack of jobs in places people want to live. I know several peds endo fellowship trained physicians (and also peds onc trained) who had to 1) work as hospitalists, or 2) moonlight as critical care “front line providers” (which is a job populated primarily by nurse practitioners), until a spot where they wanted to live opened up.

          • Alyce February 6, 2022 at 7:39 pm

            I don’t know if I ever mentioned that, when I was 14, my older brother died at 19 from complications related to his Type 1 diabetes. When my daughter received her diagnosis, my mother shared that her biggest regret was that he didn’t have proper care from a pediatric endocrinologist – he went to adult endocrinologists because that’s what was available, and my mother thought his diabetes management suffered greatly because his doctors weren’t well versed on age appropriate care. My brother graduated from high school at 16 and went to college in NYC, and having better tools that were just starting to become available for pediatric patients may have made all the difference. Anyways, I guess I’m just trying to say that your work is incredibly valuable. And I know that call weeks must be deeply discouraging, but I’m grateful that you are working hard to figure out how to make it work and how to make the career sustainable for you and your family, because using your knowledge and skills to help others is invaluable.

  • Reply Elisabeth February 4, 2022 at 7:53 am

    Sounds like a rough time…still. I’m so sorry, Sarah. In addition to work you have so much life stuff to deal with too – kids/homework and now all the house stresses. I can so relate to the latter as we had something similar happen with our house – we had 1 month to get a few issues things fixed or insurance wouldn’t cover us…but then we we went to fix the problem only to discover there were other, bigger underlying problems that had to get fixed first. We were literally at a point where we might have no water/sewer coverage for our house. It was beyond stressful and I ended up being home alone with two little kids in the middle of a deep-freeze with someone jackhammering up my basement floor and a whole excavating crew digging out the sewer line. It’s done, but even after 4 years I am still legit traumatized by the experience. I love modern conveniences and indoor plumbing but wow – there is just SO much that can go wrong with a house.

    Your situation clearly sucks and you’re understandably miserable. It feels like a very hard fit for your personality. I’m curious what Josh thinks about how you’ve been feeling lately? Does he have any wiggle room in his job? Could he ever reduce his working hours at all so that he had a bit more flex time to support things on the homefront? You’re carrying a lot of big burdens + have an upholder personality and clearly need a break from all the pressure. Maybe instead of you trying to to ease off at work, Josh could in some way? That might not be an option, but it feels like he would be a lot less stressed by juggling work and home responsibilities and if he could help out a bit more in that aspect it might relieve a lot of pressure on you? I told someone last week – I don’t need more money or more childcare, I need another spouse. To that end, we’ve made the radical decision for my husband to take a 6-month (mostly unpaid) sabbatical. Obviously not something every job will allow, but after a decade of me managing the household + doing my own stuff…I just can’t keep going. I’d rather have less money and be more happy.

    • Reply Sarah Hart-Unger February 4, 2022 at 8:05 am

      Our nanny doesn’t mind doing more. Her hours are actually a lot lower now most days (we drop the kids off at school) while we still pay her full time, and she is completely willing to stay later other days. But I have to let her.

      • Reply Elisabeth February 4, 2022 at 8:22 am

        I don’t have childcare of any sort at this point, but I still feel so differently when someone else is involved vs. my spouse with general life stuff. I feel like I have to “apologize” in some way when I ask someone I’m paying to do things. Like helping the kids with homework/checking it. Taking the kids on the weekends.
        This may just be me being weird? But I just feel like I need to share the emotional burden and can only really do that fully with my spouse? I could tell I didn’t want/need to outsource more (which just does take more juggling of schedules and wanting to make sure the person is getting paid enough/isn’t feeling overworked)…I needed the help to come from my spouse.
        But this might not help in your case and sounds like you have a lot of flexibility with your nanny which is awesome. Could she stay and get the kids to bed some nights? Like 100% get them to bed so you don’t have to do anything around bedtime at all?

        • Reply Sarah Hart-Unger February 5, 2022 at 7:30 am

          I should probably be upfront about what could help during my call weeks. Since they aren’t frequent it really should be doable. Josh is not the answer (this week he was on call too, and honestly i LIKE putting our calls together b/c otherwise it seems like someone is always on, and weekends when either of us is on call are not much fun.)

          • Perfectly Cromulent Name February 8, 2022 at 4:54 pm

            Maybe review your call week blog posts and comments a few weeks before your next call week so you can take some action steps, even if they feel ridiculous while you are doing it- like order a case of water and granola bars to keep in your office, ask the nanny to do all bedtimes that week, prep some crock pot meals or hello fresh or whatever you can do to have dinners taken care of that week…get all that lined up. See how the call week goes with that help vs without that help. I know I’ve not done things like that because the week before it seems ridiculous to have all that help, then I regret it when I’m stressed to the hilt during The Week of Doom. It does not have to be EVERYTHING- maybe just two or three things!

    • Reply Coree February 4, 2022 at 10:04 am

      My husband has had a few recruiter emails lately, with much higher salaries, and honestly, I think we’d end up paying for more of the things we like doing – working in the garden, cooking, collecting our kid – to be done for us? Like his job is straight 35 hours, I work in another city, this works well for us? And maybe we’d put the extra money into savings, but maybe we’d spend it on an electric car and a really nice hotel?

      • Reply Sarah Hart-Unger February 5, 2022 at 7:31 am

        oooh interesting dilemma. Definitely draw out a detailed picture of what each option would look like. Maybe better to wait for a higher offer in your own area 🙂

        • Reply Coree February 5, 2022 at 12:44 pm

          Yeah, I don’t think it would work for him to take on a potentially longer hours post while I work a plane ride away. Right now, his job is really reasonable and family-friendly, and it seems silly to screw with that, even for more money. We have all of what we need and most of what we want…

  • Reply Anon February 4, 2022 at 8:33 am

    If you still have your nanny working for you while your kids go to school most days, I would shift her hours each month so that she provides coverage for most (if not all) call evenings until close to bedtime and I would also put her in charge of packing healthy snacks/food for you to bring the following day. I think your expectations of what you can do alone with three kids over call week should be lowered even further – it will be more manageable when the kids are older but for now I would ask for the help where you need it. You are so lucky to have a long term nanny, she’s clearly devoted to your family, so I think it’s ok to talk about where the help needs to be prioritized over the course of a year. Feel free to keep venting on the blog though! Helps the rest of us too to hear all of this.

    • Reply Amy February 4, 2022 at 3:28 pm

      This sounds like a great idea! Sarah, I feel like you spend so much energy fighting against what call *is*, which is stressful, difficult and draining. I think accepting that and finding solutions where you can, instead of resisting the fact that it’s hard, could be really helpful for you. Good luck with the second half! You’ve got this.

      • Reply Sarah Hart-Unger February 5, 2022 at 7:32 am

        “accepting that and finding solutions” – yes. Great perspective.

  • Reply Stephanie Large February 4, 2022 at 8:54 am

    Do you have fewer patient appointments during call weeks? If call weeks are scheduled well in advance then you should be able to easily say that for call weeks you only see half or 3/4 of the normal number of patients you normally see, and use those appointment times to see to call cases or catch up on notes or something.

    I hope you figure something out. And I hope the house gets fixed soon.

  • Reply Heather February 4, 2022 at 9:13 am

    Would it be appropriate to talk to someone about your anxiety and dread around call? I feel like you should not have this much anxiety about something in your job. I know that I have worked with a counselor in the past to talk about the terrible parts of my job and it has been helpful to brainstorm some solutions to make it better.

    Also, as other people have said, I would definitely take advantage of your childcare options.

    • Reply Amy February 4, 2022 at 3:30 pm

      Totally agree with this — I think we can all empathize with how stressful call is, but it seems to cause you so much misery and I think it would be worth untangling that some.

    • Reply Sarah Hart-Unger February 5, 2022 at 7:33 am

      totally want to do this. I just need to find the right person which seems like a challenge. but one worth pursuing.

  • Reply Elisabeth February 4, 2022 at 9:25 am

    Also – I think this would make a great BOBW episode. Let’s be real – sometimes it DOESN’T feel like we have the best of both worlds and I really, really think your audience would appreciate hearing the real stories of people struggling (and maybe not even having to have a neat resolution by the end of the episode)? I know these challenges come up in your conversations with Laura, but highlighting them for an entire episode could be very useful for people to hear?

  • Reply MP February 4, 2022 at 9:50 am

    Love your solutions. One idea-can you make your outpatient visits that week follow up patient heavy? Know sometimes follow ups get complicated too. But wonder if that may help? Also no overbooks on call week on outpatient clinic and one spot (two) held for urgent adds (that way your less likely to get overbooked?). Just some ideas. Think your diabetes algorithm idea is great. Is that something your resident could work on and then you/rest of team finalize? Seems like it would be a win for everyone in your hospital system.

    • Reply Sarah Hart-Unger February 5, 2022 at 7:34 am

      we do see reduced patient volumes on call. it’s not reduced enough though! I don’t think it’s out of lack of care by our admin, I think it’s just we are completely understaffed right now from a physician perspective (this happened post pandemic) and there is nowhere else to put these patients who need carer. we ARE hiring though (hence the two interviews yesterday!).

  • Reply KDR February 4, 2022 at 10:11 am

    First of all, I love that you problem solved your own problem! Even if you can’t implement many of these ideas on your own, you now have a better sense of what you would want and can push for it if/when it comes up.

    Many of my ideas mirror those of previous commenters. I’m reminded of Maslow’s hierarchy of needs and think that solving the food/water issue will give you more energy elsewhere. You don’t talk about cooking on here much, but is meal prepping something you would consider the week before call? I was thinking something like prepping and freezing smoothie ingredients that you can throw into a blender in the morning and eat on the go. Or making and freezing a batch of soup or lasagna that you can heat up in a microwave (I’ve been obsessed with this one all winter: Another good food option would be to ask your nanny to set aside or prep snacks and/or lunch for you on call weeks. I imagine that might feel weird but it’s something small that may have huge benefits.

    My other thought that hasn’t been mentioned yet: are you interested in meditating at all? I ask because your description of scrolling the Internet while exhausted sounds really familiar to me. While in busy seasons, I’ve found that taking 10 mins to meditate (I use Headspace) before I sit down to scroll helped me decompress faster. But I’ve also always loved meditating and I know it’s very unpleasant for some people. For me it feels like an awake nap.

    Anyways, sending you strength and support. Thank you for sharing all of this with us.

    • Reply Sarah Hart-Unger February 5, 2022 at 7:37 am

      We have been using PrepDish meal prep recipes/instructions for our dinners and our nanny is the one who executes on this, which is great (full disclosure they are a podcast sponsor for BLP, but I truly love the menus/concept/service and use it regularly). It’s lunches where this falls apart! Honestly next time I need to basically bring a bunch of high quality frozen meals + snacks in on Tuesday, put them in the office fridge, and take care of myself in that way.

      I do use Headspace most mornings but ironically all of my habits go to absolute *$@(# when i’m this stressed, so . . not this week.

  • Reply Bryce February 4, 2022 at 10:18 am

    I think #4 would help a LOT, and also scheduling call around GME schedules (so you are not taking call when doing lots of interviews, or if it’s interview time someone else takes the lead). I think the problem is when you take call you are just adding a third job onto your existing job(s). If call was the *only* thing you had to do that week, maybe it wouldn’t be your favorite week, but it wouldn’t seem so insurmountable?

    • Reply Sarah Hart-Unger February 5, 2022 at 7:38 am

      agree, but not always actually doable. but yes, clearing things out to the extent possible is definitely important and I should be more aggressively protective of the week!

  • Reply Grateful Kae February 4, 2022 at 10:21 am

    As I was reading this, I was thinking, “if this were me, I would have my mom come and stay with us during call weeks.” (She lives an hour away.) Then I would feel ok just basically checking out of all other responsibilities for that stretch knowing the kids/house were covered. It seems family support isn’t an option for you guys though since I never hear you mention that. So I don’t know- could you shell out more to have your nanny basically stay overnight/be live in on call weeks?

    I work in Transplant and when I worked in the hospital we had fellows and residents that covered call, but at one point they did move to a Night Shift only NP/PA group whose only job was to cover call. It… kind of worked but seemed messy. Since they weren’t around during the day to be up on “everything”, and I’m not sure they all had oodles of transplant experience prior to this role, it always felt a little questionable! I mean, they were still good/tried their best, but at least in this field there were a lot of big important decisions, post-op management, crucial things going down all the time in the middle of the night, and it seemed like it was maybe asking more of them than they could realistically give. I remember often thinking that it was not the perfect solution and they seemed miserable and kind of overwhelmed constantly too.

    I think I like your idea of shorter call. I think the people on call should be able to be as fresh and willing/enthusiastic about call as possible- because I’ll tell you from the other side, having over stressed/crabby/strung out on call providers that the nurses then end up being scared or hesitant to call is a terrifying thing for patient care.

    • Reply Sarah Hart-Unger February 5, 2022 at 7:39 am

      I could have our nanny work ~2p – 8p every call day and help me put the kids entirely to bed. Honestly next time I should just set that expectation. She would not mind whatsoever. It’s my own guilt that prevents me from asking.

      • Reply Hilary February 5, 2022 at 8:15 pm

        You absolutely should! I mean, you’re already paying her for it! I love how generous you are with your nanny but in this instance it really seems irrationally generous. Like, let her work the hours you are paying her :). I have a friend whose nanny works 12-8 every day, for what that’s worth. Works great for everyone.

      • Reply Alyce February 6, 2022 at 8:35 pm

        Consider being on call as being akin to having to travel for work in terms of your availability for childcare, household chores or household management. Would you feel guilty if your job required you to travel for six weeks over the course of the year? Probably not. You would make the arrangements you needed for your household to run smoothly in your absence, you’d connect with your family in brief intervals through video calls before bedtime, you’d prioritize the things that can be done with regards to food and exercise that can be done within the constraints of travel, everyone would just make do and it would be okay.

        Knowing that your work is especially demanding these six weeks of the year is an opportunity to prepare for the onslaught. The misery is finite. When I have rough periods at work that are unbelievably stressful, I literally never know when they’re going to end. I just have to hold onto hope that eventually, things will calm down and I can get a breather because, historically, things have calmed down in the past. And when they do calm down, I absolutely have to take advantage of that time to recover and restore so that I can withstand the next rough period, because it will come again, depending on the whims of others. It is a huge advantage to know when call is coming, and knowing what the pain points are, and doing what you can to alleviate the pain points, both individually, and perhaps also on a systemic level.

        So I guess one of my questions, given the list you’ve proposed in your post, is who exactly is empowered to make the changes that you’ve laid out? Who is the decisionmaker? Who are the non-decision making stakeholders involved? Are there ways that you can influence these groups? Is it building coalitions with the other people who are impacted by the awfulness of your call schedule? Are there strategic inflection points that can impact whether your proposalscan be considered? Is hiring additional physicians actually going to provide an opening to re-evaluate how call is handled in your department? Or perhaps the next time the call weeks are assigned? Perhaps now is the time to reach out to others to see if you can build support among your fellow doctors about changing how long call last.

        I know that these suggestions are a call for you to do more at the same time you’re worn out and want/need to do less, so I get it if none of these ideas sound appealing. But I think you may also need to think strategy as well as troubleshooting solutions if you want to see some change. Is it tiring getting neverending advice from strangers on the internet?

        • Reply Kathryn K. February 7, 2022 at 7:12 am

          Alyce – Fantastic points on both getting through a tough time and on strategies for getting change made.

  • Reply Irene February 4, 2022 at 12:46 pm

    Your call weeks sound insane to me. I could not do it! It seems strange to me that you are covering calls during the work day when you are with other patients. Don’t you have a triage nurse or something during that time? I get confused how much you are in a hospital vs office setting but this just sounds impossible. Maybe I’m not picturing it right.

    I think it’s important to acknowledge that some things are really really hard. And it’s not your fault for having not fixed it to be less hard. With that said I think you should schedule some time to start kicking around ideas for how to make this better with your closest colleague in a week or two, because it’s not great for your patients either for you to be stretched to capacity like this.

    You and your husband both have big jobs and I don’t think extra childcare is always the best solution if it’s not what you want.

    Anyway good luck and those shoes look awesome.

    • Reply Sarah Hart-Unger February 5, 2022 at 7:41 am

      Yes, literally WHILE i am seeing patients my phone and computer are dinging with multiple EPICchats from the hospital. I am interrupted constantly while trying to write notes and as a result am about 20 behind (fun weekend catchup activity). You are picturing it right, and it’s really not great.

      Now that I think of it, maybe hiring a PA or NP to help with the inpatient side during days would be a smarter solution. Hmmm.

      • Reply AnnaM February 5, 2022 at 9:33 am

        Love the idea of NP/PA help. I’m not in a medical field at all but interviewed for a super entry level ($100k salary cut if I’m being honest!) hospital job last week as a surgical assistant (fetching supplies etc) and it was thrilling to consider. Obviously I’m not trained but keep in mind people at all levels can do all kinds of things and be excited about helping! You definitely can create more support in your hospital if you can have some NP coverage during call weeks. Great idea. Hang in there!

      • Reply Irene February 5, 2022 at 6:41 pm

        I would be taking handfuls of migraine medicine the entire time. OMG. Not a doctor at all but aren’t diabetes calls sometimes fairly urgent? Can they really wait until the appointment is over? That sounds SO stressful. I can’t imagine you are the only one stressing out about this type of call. My mom does phone triage during the work day so that the doctors can just see patients- if it’s a real emergency they go to the ER otherwise they batch the things that need a dr’s input for when they are available, generally at the end of the day or during lunch (it’s like 90 minutes) surely there is a solution to some of this….

        • Reply Sarah Hart-Unger February 5, 2022 at 8:04 pm

          literally every page I’ve ever gotten can wait until the visit is over. EPIC should come up with a setting that puts messages to sleep when you are loggged into an outpatient visit, letting only “urgent” flagged messages through. (feel free to hire me as a consultant, EPIC!)

          • Sarah Hart-Unger February 5, 2022 at 8:07 pm

            (PS – I guess one could say ‘don’t look at them during a visit them duh!’ but that’s the problem – you don’t know if something is urgent, and also the design is that it flashes up on your screen and is very hard to ignore.)

          • Irene February 6, 2022 at 12:09 pm

            I am so sorry if my reply sounded accusatory in any way. I was just thinking how stressful this would be, I so admire you for making it through!

          • Sarah Hart-Unger February 6, 2022 at 12:58 pm

            Oh no, it didn’t at all! It was a great question 🙂 and made me think!

  • Reply Lisa of Lisa's Yarns February 4, 2022 at 2:16 pm

    I think you should share your ideas about how to improve call. Surely your other colleagues must feel the same, so maybe the powers that be need to hear this? A week of call does not sound good at all. That is just too long of a stretch to be so… available. Is that the norm for your discipline? I’m thinking of my neighbor who is a pediatric urologist. Her call tends to be 2-3 days. And then I am familiar w/ OB call schedules from my pregnancies and their call tended to be once week and then weekends. I am pretty sure my OB had a post-call day worked into her schedule and my friend who is an OB has the same set up. So they seemed to acknowledge that their doctors were working call and adjusted the schedule accordingly? Is something like that possible – like a day off from clinic/GME during the week of call?

    I think having your nanny work longer hours would help, too. Especially since Josh seems to always work long hours regardless of whether he is on call or not… But it all sounds exhausting!

    The insurance situation is NUTS. So they can revoke coverage for a mistake that they made??? That does not seem right!! They clearly provided proof of insurance for your closing so how can they just say ‘oops, we missed something! You better figure this out in 3 weeks.’

    • Reply Sarah Hart-Unger February 5, 2022 at 7:43 am

      yes the insurance thing is making us both livid. we turned in every document as asked. it should not be our fault that they didn’t ‘notice’ something and granted the insurance anyway.

  • Reply Amanda February 4, 2022 at 2:36 pm

    After every single one of my call weeks (pediatric neurology) I am so happy to not be on call that I appreciate having to do it every once in a while (5 weeks/year for me) so that I recognize how nice it is to NOT be on call, haha. But I also have fellows taking overnight call every night which makes a HUGE difference. We also clear our outpatient schedules during call weeks, but we have both a Consult service and an Inpatient service that I have to staff so I am guessing it is often busier than Endocrinology. Hang in there and here’s hoping the weekend isn’t too bad! I think you pretty much already know all of the suggestions offered here (meal prep, childcare, etc). These weeks are so few and far between it’s fine to just need to vent after a hard day. Being a doctor is hard. I would try to lobby for as few outpatients as possible during call weeks though…

  • Reply Justine February 4, 2022 at 3:10 pm

    There might be something to hiring a NP or PA to do some overnight call if they covered enough patients or had other clinical responsibilities at nighttime (fulfill a couple of service lines and just calling the attending for emergencies/super complex?).

    We have NPs & PAs at my children’s hospital that cover the post-op surgery patients at night because the residents & fellow can’t cover all the call time due to the work restrictions. It’s an investment because of course the attendings could cover it all, but there is something to be said for provider burnout with retention & patient safety. I know someone who is an adult ICU nurse and she says that there is just 1 doctor to cover 50 ICU adult patients at nighttime so they are always in a terrible mood and tell the nurses never to call them. That’s an insane ratio…! no one can tell me that doesn’t affect patient care.

    • Reply Sarah Hart-Unger February 5, 2022 at 7:45 am

      that’s an interesting idea – a multi-service nighttime PA or NP where they could still call specialists for advice but would be first call. I wonder if anyone else has that model for peds endo!

  • Reply Cara February 4, 2022 at 3:29 pm

    As I read your list of what you did today I was thinking, wow you did so much but you’re beating yourself up. I think that list would be great to talk through with the therapist/coach if you start something with someone. From the outside I could reframe that whole list into a positive list of amazingness for sure (including the food and the non homework checking; you found food in a timely way, you knew your limit and didn’t add more stress/kid drama with the homework). I think a therapist/coach could really help you work through some of the pressures here, external and self imposed, and help you find relief. You’re doing A LOT, and doing an AMAZING job but as I read this I found myself wishing that you could see that instead of being so hard on yourself about what you didn’t do fully or perfectly.

  • Reply coco February 4, 2022 at 6:14 pm

    sounds like a stressful week and I’m sure you’ve tried different solutions over the years. Given that this is a recurrent issue and is expected to be repeated, trying out new ways to deal with it at least gives you the hope that eventually it would be less painful. Just throwing out some own experience when I know a stressful week is coming.
    – as suggested above, I’d either meal prep for the family and freeze them, or plan for super simple meals that takes 5 min to make.
    – let go of expectations about kids behaviors. I am usually strict about them finishing their homework of the day before going to sleep. But on those “special weeks” I let it go.
    – invest either more on selfceare. During January I had two stressful weeks and I read more than ever. I made sure to have solid 60 min reading to calm my mind before going to bed as ensuring a good night of sleep is non-negotiable.
    – let go of exercise and guilt free. Instead of a run that might stress my body more than it can handle or gym session for my case. I switched to yoga and walking.

    Hope you find a better way to deal with the call weeks.

    • Reply Mrs. Candid February 4, 2022 at 11:37 pm

      I am a SAHM, I left my job after my daughter was born. I had to leave because of the circumstances at that time, and then life kept unfolding in such a way that I could not think about getting back to work force until my kid turned 4. But by then I was having so much fun with my daughter, cooking fresh food for every meal (I didn’t know I was so passionate about cooking and trying new recipes when I was working and eating out often) and just being available for my family. 

      When I started thinking about getting back to work, it felt like I was outsourcing my wonderful life for someone else to enjoy, whereas I would go and work hard for some corporation. I would earn more and more to pay for the caregivers who would enjoy their time in my beautiful home with my lovely child. I didn’t want that. And fortunately I had the resources to allow me this privilege. 

      That said, I have HUGE RESPECT for all working women. I feel most working women in India have it easier than those in western countries. In many families, we have grandparents helping them out at least till the kids are around 10 years of age. This is usually in addition to hired household help.

      My heart goes out to all the working women like Sarah who are forced to do it all on their own. I wish I could magically appear there during your call weeks to take care of the kids and make you good food Sarah. I don’t know what else to say 😔 

      Please avail of any additional help you can get during these tough years. God bless.

      • Reply Sarah Hart-Unger February 5, 2022 at 7:47 am

        To be fair, no one is forcing me to do this job – we could survive if I didn’t. If it were like this all the time I absolutely would choose another career. But since it’s 6 weeks a year currently – I feel like it’s worth it for the 85% of the year that is so much better . . . but thank you for the support. I do not have grandparents but our nanny is really incredibly helpful + the kids’ school a great setup too.

    • Reply Mrs. Candid February 4, 2022 at 11:39 pm

      Sorry I don’t know why my comment came as a reply to this thread 🤔

    • Reply Sarah Hart-Unger February 5, 2022 at 7:45 am

      thanks coco. Yes I have barely worked out this week. But I think that is adding to my stress. I need to run today!!!

  • Reply Amy February 4, 2022 at 10:08 pm

    Sarah, I’m wondering, do your coworkers face the same stress and anxiety around call? Does Josh? If not, what are the strategies and approaches that they use to help them get through it?

    • Reply Sarah Hart-Unger February 5, 2022 at 7:49 am

      ooh, great question. Josh gets grumpy and has less patience when on call (he may deny this, but I see it, ha!!) but it’s absolutely nowhere near the extent of my emotional lability when on call. My colleagues all dislike it and often get pretty stressed, some handle it better than others. One of them in particular is pretty impressive with her level of calm despite the fact that she has multiple kids at home and is the primary parent! I should ask her for her secrets 🙂 (And actually I might – I’m getting coffee with two of my colleagues on Sunday. Again, despite this call angst, I really really love my group – so grateful to have people that I really trust and respect and enjoy working with.)

      • Reply Amy February 5, 2022 at 8:27 am

        You truly should ask her her secrets!! It could be something like “my nanny works evenings those weeks and I don’t feel guilty”, ha. I also wonder if just accepting that you’ll be behind in notes (do you feel like you should be able to keep up?) and not letting that be a source of stress would be helpful.

      • Reply Mary February 6, 2022 at 9:04 am

        Please share her secrets with us!

      • Reply Alyce February 6, 2022 at 7:29 pm

        A former coworker had had a series of really big jobs (that I had known about before ever meeting her – she was literally someone I had looked up to professionally and whose bio I looked to as a career trajectory I would arguably wanted). She went to law school in her late 40s/early 50s and joined my office a year or two after I did (I was in my late 20s) and I was assigned to be her buddy. It was literally a hardcore fangirl and had to pretend I could somehow guide her in some way(ha!). But she arrived when I was going through a really tough time, and knowing her experience, I asked her how she managed her stress and she proceeded to lay out a thoughtful and comprehensive self-care plan developed and tested over decades and in much more challenging situations that I faced, and it was truly life changing for me. I am not at all exaggerating when I say it changed my professional and personal life. Some of her suggestions resonated with me more than others and I still had to tweak her suggestions to make them tight for me, but the blueprint got me moving and gave me direction when I felt utterly lost and hopeless. And simply by asking her for advice, it transformed my relationship with her, and she’s been a close ally and mentor ever since. It is one of my most cherished professional relationships. I highly recommend being vulnerable at work, and seeking out guidance and advice from other who truly know what you’re facing (because as much as your internet friends want to help, we are limited in what we know about your situation, and many of us – myself included – project our own issues onto your situation).

  • Reply reallifeinutopia February 5, 2022 at 3:48 am

    Gosh, I am echoing what a lot of people already commented. Wishing you the strength to get through this! I do think it would be weird if you didn’t feel stressed. Call week, full time job+3 kids+2 podcasts, busy surgeon husband. I would not know how to handle that either. And I also don’t even check if my kid brings his homework to school, or if he has any, it’s all on him.

  • Reply Annemieke February 5, 2022 at 8:27 am

    Love the shoes!

  • Reply Kelsey February 5, 2022 at 12:11 pm

    What a hard week, Sarah! I echo what others and you have said: get more nanny help and “throw money” at other call week stresses too where ever possible. Maybe you could make a standard grocery list of food/snacks to have during call week. A mixture of quick-healthy-filling things to keep you fueled and some treats too to look forward to. You could even save that as a separate saved shopping list if you do grocery pick up and ahead of call week just select all, order, and pick up/deliver.

    I have also been reflecting how in my own life a toddler just makes everything a harder no matter how organized I am. I know you don’t have a toddler any more but I bet that call weeks will get SO much easier once all three kids are pretty self-sufficient. Which is all to say – get all the help, pay all the money during call week right now to help yourself out. And I bet ultimately you will not need as much extra support in just a couple of years. So don’t feel guilty about getting the help that you need. That is SO much on your plate!

    I also 100% agree on finding a counselor/therapist to see regularly. Asking local friends (if you are comfortable with that) could be a good start. I recommend my counselor to local friends frequently! It can feel overwhelming to find someone but when you do it’s a really great resource and practice to have in your life that I think you will find supportive.

  • Reply Kim N February 5, 2022 at 5:45 pm

    Sarah – I came here to say what so many already have – have the nanny stay later or just move in for the whole week of call. If you are working essentially 24hrs a day (or have to be available) there is no reason you shouldn’t have 24 hr childcare those days. And yes to having the nanny meal prep your breakfasts, lunches, and dinners that week. Or paying for premade meals to bring with you. I agree with you that when I am stressed/busy even ordering something for delivery seems like too much work, so having this all planned in advance on a non-call week would be key.

    I also love the ideas you have for making this better for everyone in this job – not just you. And I would absolutely encourage you to discuss these ideas with your coworkers and superiors. It is in EVERYONE’s best interests to not have our health care providers burn out and leave the profession.

    And on that note, you are a doctor rounding out the second year of a pandemic – every single person I know is feeling the stress of this, but especially those in health care. Those in health care who are also married to people in health care, and who are also parents – well that is a very specific subset of people who have every reason to feel stressed out. So, basically, it’s not that you are doing it wrong – it’s that the circumstances you are in are incredibly challenging.

    Sending you love and many thanks for all the work you do.

  • Reply Leah February 5, 2022 at 9:38 pm

    This is tough and something that seems to be tough each time, no matter how you tackle it. For me, the guilt of being near my kids/home but not focused on home is part of feeling overwhelmed. When I had a recent, expected but overwhelming week at work I decided to try to make it a positive and give myself literally NO at home duties. I know not everyone can do this, but if your nanny can stay later (until Josh gets home) only for the 6 call weeks a year, you may want to try it. I moved out! Seriously – I moved to a AirBNB and all I did that week was work and self care. I hope this is a safe space to admit that and I know the privilege I have to be able to do so. My childcare and husband covered it all. When I wasn’t working or reacting to work crisis off-hours, I could exercise, read, sleep and generally just NOT deal with household duties on top of the work needs. It was manageable and in a small way turned a VERY hard work situation into small moments of self time. Pre-COVID I used to go to several week long conferences away from home and my household ran fine while I was away, so I just “worked from AirBNB” instead of “work from home” and pretended I was on business travel. Maybe you could try this out next call week and see if it helps. I even managed to meet a girlfriend out for a late dinner one night after a LONG workday!

    • Reply Mrs.Candid February 5, 2022 at 10:08 pm

      This is a great idea Leah, an option that wouldn’t occur to many, but yeah, if it’s possible then why not 😀

    • Reply Mrs. Candid February 5, 2022 at 10:27 pm

      This is a great idea Leah, an option that wouldn’t occur to many, but yeah, if it’s possible then why not 😀

  • Reply Lani Inlander February 6, 2022 at 8:02 am

    Love your constructive list of solutions. You should campaign to get them implemented at your hospital! Why not??? Also, definitely order full boxes of healthy snacks you like and flavored smart water (pineapple kiwi?!) to your office to have on hand. Love the shoes. I’m sure they look great with black pants and your lab coat! Comfortable shoes always make one feel better. Good luck!

  • Reply Marthe February 6, 2022 at 10:43 am

    Oof… so sorry for you! Could you check yourself into a hotel at least one full call week? And have Josh + Nanny + extra (student?) nanny handle the home front? This probably is a wild and “indulging” and “too luxurious” option, but to me it sounds super nice!

  • Reply Marthe February 6, 2022 at 10:44 am

    So, what Leah said 🙂

  • Reply kelseywharton February 7, 2022 at 10:46 am

    P.S. I also LOVED all your ideas for making call week more manageable and I am hoping there’s a way for you to share those ideas up the chain. They sound practical, like they could even be cost-saving, and would make call week better for everyone. All they can say is no, right?

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