Midweek Check In

January 10, 2024

Call Report

(I have received feedback from some that reading about how I sometimes struggle with the challenges of overnight call is triggering to them — if that is you, please feel free to skip this post though I will note things have been overall very good so far this time around!)

It’s only Wednesday, but I have to say this is the calmest I have felt during a call week in a long time. I want to capture this and figure out what I’m doing right so that I can refer to it if/when I have difficulty in the future.

Things That Are Working:

1- Not overstimulating myself. So it’s a new year and I tend to be extremely affected by NYE (New Year Energy). Thus I have been rocking my goal of sticking to my media-related goals and you know what? It’s very calming NOT to be staring at a little screen spewing information at me at every quiet moment!! Scrolling was my ‘escape behavior’ of choice on call for years and dare I say it may have been making things worse!? What a revelation!

2- Being ruthless about going to bed (and putting Genevieve to bed). Josh and I recognized recently that G was not getting enough sleep. I think this is much more common among ‘later kids’ (ie, kids with older siblings) because it’s not realistic for our home to be in shutdown mode for everyone at 7:30 or 8 pm, so she just ends up going along for the ride with a later bedtime. (Or possibly this isn’t true and Josh and I just got lazy.)

ANYWAY. We decided that we would start being very strict about starting Bedtime Routine (brush teeth –> reading stories in bed) at 7:30 pm rather than just starting when she started to get ornery (don’t recommend) and not only has she been getting better sleep but I have found myself going along with her. I often get sleepy while reading to her and transition to reading in my bed.

Sometimes I do get called at 9 or 10 pm but sometimes I don’t. Last night I got called at ~3:15 AM only, and I was sooooo happy that I had gotten to bed early for those 6 hours of uninterrupted sleep! Lesson: don’t try to stay up on call because someone might call. Especially if you were previously doing that by anxiously scrolling (see #1)

3- Remembering that sleep deprivation can be hard at times, but at least my situation is temporary. 7 nights is a lot of nights, but no one ever died from ~7 bad nights of sleep every 10 weeks or so. And truthfully, every night isn’t usually bad (just a few are, maybe 50%) so I need to put things into perspective. It’s about 10x easier than waking up with an newborn for months and also 10x easier than waking up with a sick child (which is sometimes what I’m getting called about. And even though I’ve already clarified this in the past, I will reiterate here that I am not mad at those who call our emergency line! They 100% should if they need help). So yeah. Just generally releasing the ‘this is a catastrophe’ vibe that I sometimes get about my bad sleep during these weeks.

(RELATED NOTE: I do not alter my early running schedule on call weeks, but it’s always an option if things get really dire. I feel like my AM runs really help my stress levels so I don’t want to miss them during an already-stressful week but it’s good to remember that this is also a lever to pull if truly needed.)

4- Asking (calmly) for what I need. The kids were being loud during a patient call, so I turned around and told them as calmly as I could that I needed them to be quiet so I could hear the nurse who was asking questions. I also alerted our nanny that I might need some extra help with bedtime/later driving shifts (Josh often does these but on occasion he will be stuck in the OR and not being able make something like 8 pm dance pickup).

5- Keeping my call notebook close + doing lots of prep for each patient. Writing things down ALWAYS HELPS. I took detailed notes on a patient’s feeding/insulin regimen (more than I normally would) and it ended up coming in handy. I have been doing more chart prep in free moments (ie: during quieter periods I will pre-template all outpatient notes and review charts; sometimes things get hectic in the afternoons with simultaneous inpatient and outpatient stuff so best to be over prepared.

This is my call notebook — I encode any pt data (ie no names/identifiers etc) and shred it at the end.
It is my analog call brain extension!

6- Not creating deadlines that don’t exist. I sometimes do have to leave the office by a certain time (Monday = ballet pickup at the same time as C’s soccer starts is an example) but most of the time I don’t. I got stuck in this mindset of “must finish by XYZ time” when truthfully most nights it is NO BIG DEAL WHATSOEVER what time I finish. It’s not as if I have to stay late most nights, but having the option to do so on the rare occasion it is needed takes away the “I must race to the finish line” pressure I used to put on myself. I seriously think it stems from the pumping/nursing days. That ended over 5 years ago, so I am long overdue for a paradigm shift!

7- Clearing the decks prior. I did a better job this week of finishing podcast-related tasks before the dawn of Monday morning (when call begins). I don’t have anything ‘due’ this week. I have always tried to avoid this but have not always been successful. One of my big pushes this year is to really strategically get my business-type work done ahead of schedule (which involves not filling my creative-work calendar to overload levels) so hopefully this trend will continue.

8- Keeping my to do list minimal and loose. Sometimes I do have downtime, so it’s reasonable to put a couple of “life admin” options on my daily to do list. But I need to hold these loosely and be very judicious about what I put on there.

(Case in point: I ordered our New Year’s Cards yesterday! I know, late, but I decided over a month ago that I didn’t care if our cards came out in mid-late January and so here we are. This was intentional planned neglect 🙂 )

That was a lot. And it’s too early to declare “VICTORY OVER CALL!” or something like that. But I still want to note that this is progress and maybe just MAYBE I’ve figured a few things out over the course of many years.


Two unrelated activity notes:

#1: C made the school basketball team! This is awesome for him. It also means that the relative chaos of Nov/Dec will now repeat itself (he was doing school soccer / travel soccer and now will be doing school basketball / travel soccer; the soccer season goes August –> May).

On the plus side, it looks like I will be able to attend a lot of the games! Soccer was more hit-or-miss due to BLPA being held around the same time.

#2: I got an email about the “Parent Dance Class” at our kids’ studio. I think this is to prep for the Parent Dance that is part of the annual showcase. Last year as I was watching I though it would be fun to do but now that it’s actually approaching it’s slightly terrifying. I sort of feel like I should just go and see how it is with no pressure to ever go again if it sucks. Has anyone done anything remotely like this (Sarah J?) and what was it like!?!?

(I haven’t danced since 1998 and that was only in the context of competition cheer. And I’m pretty sure I wasn’t very good even then . . .)


  • Reply Amanda January 10, 2024 at 6:14 am

    Would you be willing to share how you use your call notebook? I feel like writing things down on paper really helps me remember things (surprise that I read your blog lol) but I’ve struggled to implement a system that works for me since becoming an attending. As a resident I often had a notecard for each patient, but with so many patients as an attending that didn’t work. Also probably not as HIPAA compliant as it should have been. Do you take notes on each patient in the notebook but just not write down their name/any identifiers? Do you also keep your printed patient list for the day and take notes on that?

  • Reply Amanda Koehler January 10, 2024 at 6:26 am

    I totally agree about the younger kiddo bedtime creep. We were just discussing this for our 8 year old. She’s out youngest and has been going to bed at 9 which is wearing me out. We have several friends where 8 is the oldest and those kiddos are going to bed an hour earlier. We did a big reset on bedtime routines this week. Kids weren’t happy but it’s going well for me so far! I need time to myself at the end of the day!

  • Reply Amy January 10, 2024 at 6:31 am

    Sarah, I have been reading your blog for years and I have to say the changes you have made over the years in approach to your call weeks are huge. This used to be such a struggle for you and now it seems like you’re the one in the driver’s seat rather than being flung around at the mercy of your schedule and obligations. Im not surprised that you feel differently about it all now, even if it remains a challenge (and always will).

  • Reply ccrinma January 10, 2024 at 8:40 am

    Three cheers for intentional planned neglect! So glad for you that you’re figuring out what works and what doesn’t.

  • Reply Omdg January 10, 2024 at 9:37 am

    If we do activities, it is physically impossible to get to bed on time. She finishes at 7:30, then has to come home, shower, eat… bedtime is 9:30 if we really hustle, and she does so much better with 9. Also *I* go to bed at 830 and cannot monitor her. Not sure there is a solution. The one nice thing about having school be not-challenging in any way is that you can have your kid do activities, and I will not let her fester on the iPad every evening.

    • Reply Sarah Hart-Unger January 10, 2024 at 10:15 am

      The only night that G has a late activity is Tues (gymnastics 6-7:30). Other nights the big kids often have later activities, but G doesn’t so we are dividing and conquering. Josh usually handles the late soccer pickups and I can be putting G to bed on time. At age 6 luckily there aren’t too many late things. There def are for the other two though (jazz dance for example is 7-8 pm, soccer ends at 7)

      • Reply Omdg January 10, 2024 at 10:20 am

        What time do they get up in the morning? Dyl has to get up at 6:30 to catch the bus and I cringe that my 11yo gets the same amount of sleep that I do. She really needs about 1hr more.

        • Reply Sarah Hart-Unger January 10, 2024 at 11:46 am

          A gets up 6:30 and C gets up 7 (A likes her longer AM routine 🙂 ). They go to bed 9ish most nights. Sometimes C stays up later watching sports with Josh but not all the time. They don’t seem super irritable and tired the way G has been lately.

          Josh is definitely the one in charge of big kid bedtime lately though it’s not as much work as they have gotten older.

  • Reply Natka January 10, 2024 at 9:50 am

    Yes about the youngest kids and later bedtime! This is absolutely the case with our 9-year old. Big siblings are 13 and 15. We are definitely on the big kid schedule – because they have activities that run late (sometimes as late as 9pm and they don’t get home until closer to 9:45 – that’s only once a week, but still hard). Because of the overall family dynamics, it has been very hard to get the 9-year old to bed at a reasonable hour (if she is in bed before 9:30, I call it a win.. but then she’ll sometimes stay up and read until 10 or even later…). The big kids complain “when we were her age, you made us go to bed at 8:30!!! Not fair!!!”

    The type of shows and movies we watch as a family is also a lot more grown up than I would typically be comfortable for a 9-year old. It’s hard to find something that is fun for the teens but still appropriate for a younger sibling. We’ve been watching Teen Wolf… and I was thinking to myself – no way I would have allowed the older siblings to watch it when they were her age…

  • Reply ARC January 10, 2024 at 10:46 am

    YES to doing the parent dance class. I bet you will love it. I have been trying to psych myself up to go to this place called “Diva Dance” which is basically hip hop dance class for grownups in a non threatening atmosphere and I’m still too afraid. I know I’ll love it if I can actually get there 😛

  • Reply Amanda January 10, 2024 at 10:52 am

    Love this post! FWIW — I also have call and you writing about this topic is very helpful.

  • Reply Sarah January 10, 2024 at 11:14 am

    Our studio does not have parent dances, and I am glad because I cannot dance at all (I once took down an entire small-town beauty pageant kick line) and would maybe have a panic attack if I had to participate. BUT my friends with dancers on FB have this option and take advantage of it and look to be having a wonderful time. (Our studio does a really impressive teacher dance that is my very favorite part of the recital). Also! Early bedtime for the youngest! We ARE TERRIBLE at this. Minnie goes to bed at 9 some nights, and it is terrible for her and for us. Our other kids were asleep by 7pm for years and years and year. Gah.

  • Reply Lisa's Yarns January 10, 2024 at 11:32 am

    I’m glad that you’ve found changes to make that will make call less miserable for you. 7 days of call is such a long stretch! I am friends with a good number of physicians and none of them have 7 day stretches of call! It is very hard to adjust to being woken in the night after a stretch of that not happening. Like I think back to the ear infection stretches and how we’d be up 3-5 times A NIGHT with a sick kid. And it was hard, but in a way, it was less hard than sleeping well for months and being up 2-3 times? Your body kind of gets conditioned for wake-ups when you do them often and then your body seems to adjust to not getting woken up. I know you had your call kind of concentrated in the final 2 quartiles of 2023 so hopefully it’s more evenly distributed this year!

    The bedtime thing is tough. I would like to put our 3yo down a bit earlier, but he’s awake when we go in to get him at 6:20 nearly every day so I think he is getting enough sleep? He goes down around 7:15. Our 5.5yo goes to bed at 8 and gets up pretty happily at 6 – sometimes on his own, sometimes I have to wake him up.

  • Reply Jessica Blanchard January 10, 2024 at 2:15 pm

    I love the idea of keeping a call notebook. What type of notebooks do you use for this?

  • Reply Elisabeth January 10, 2024 at 7:02 pm

    I took a screenshot of your point about “intentional planned neglect.” I remember a book once that talked about planning to fail at things. It’s so counter to our personalities, but letting things go PURPOSEFULLY puts all the power back in our court. And I for one LOVE receiving cards well after the holidays. It’s such a boost in the long, dark days of winter. So I think the recipients will love this bright spot in their mailbox even more than if it arrived at Christmas/early New Year’s!

    • Reply Sarah Hart-Unger January 11, 2024 at 5:36 am

      I need your address then 🙂

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