Call, fatigue, and remembering what's important

​This week is a call block, which means yours truly is on call for 7 days in a row for Ob deliveries, if my colleagues need someone to do a C-section, and at times for all admissions to the hospital (adult or peds) and q15 minute calls from the nursing home. Call is always feast or famine. It could be boring. It could suck rocks. I work in a small, rural hospital, so FP’s do pretty much everything here.
 
If you live in a big city, then this job may seem like the unholy love child of Marcus Welby, M.D., Dr. Quinn Medicine Woman, and Dr. Joel Fleischman (Northern Exposure). And you’d be correct. The net result when I’m on my call stint? Poor sleep, putting out fires in the office and all hours of day and night, and difficulty doing anything but sit around and wait for the next call to light up the phone.

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Oh, how I love it when all 4 nursing homes call in a staggered “burst” pattern, every 5 minutes, on a rotation. How they coordinate this precise timing, I have no idea, but I stand in horrified awe when they get going. Well, not so much at 3am, but you get the idea.
 
When I had to transfer out a crashing patient last night (septic, had to be intubated because she wasn’t breathing much, acidotic), the adrenaline burst got me thinking about what it is I still like about medicine. Because there are a lot of things that push docs right up to the edge of burnout, and we should probably get some alcoholic beverages if we’re going to talk about some of the intense stupidity medical professionals have to deal with these days.
 

​So every once in a while, it’s important to recall what excites and drives me about medicine.
 
#1) It feels good to able to take care of 90% of what rolls in the door. (I didn’t mention it, but for the first 7 years of my career, I paid off a chunk of student loans by working as an ER doctor in my “free time”.)
 
#2) Instincts. They’re honed and I trust them more. I’ve developed a great “spidey sense”. Even when a patient looks “okay” on paper, if I get that weird feeling on my neck, then I’ve learned to pay close attention. It pays off. Once in a while, I’ll get a feeling and simply go to, say, the Ob department. More often than not, something’s going south in a hurry right after I get there. Kind of freaks out the nurses when I get there before they have to call me.
 
#3) Delivering babies. It just never gets old, ever ever ever. There’s nothing like that pause when the baby comes out of the C-section incision, or when the baby comes out after a tough vaginal delivery. Everyone in the room holds their breath for a few seconds. Then that baby cries and my heart starts again. Every time with each new baby is wonderful.

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#4) I can do a lot of really cool things with my hands. Like cut a human out of a human. Or remove skin cancer and put the skin back together with a minimum of scar. It’s kind of like art.
 
#5) There’s always hope that someone will do some of what I recommend. And you know what? On occasion, it happens, and man, it makes me smile.
 
#6) Even the routine is interesting. Maybe patients have run-of-the-mill diabetes and high blood pressure. But start asking about their family or beliefs or background or hobbies, and it gets interesting in a hurry.
 
#7) Most folks appreciate that I’m trying my best to help them.
 
#8) Medicine is fodder for the writing. I’m not saying that I use individual patients as models. That doesn’t happen. What I’m talking about is seeing the range of humanity, emotions, hopes, and fears that patients share. That’s sacred. That shades my writing.
 
#9) People can be hilarious.
 
#10) Old folks have wisdom. So do kids. Ask a few questions and that fact will quickly become clear.