The Black Weekend

I started another post about internal medicine a few weeks ago, but it never got finished. Regardless, I felt the need to post something today. I'm about to enter my third black weekend of residency. Today (Friday) I got to get out at a reasonable hour. Only 10 hours worked today (definitely my shortest day in the last 4 weeks). Call has been rather difficult of late. So has my service, in general. Two of our patients have died in the hospital over the last few weeks. Several more have gone to hospice care. We've diagnosed terminal cancer after terminal cancer. Patients dying is kinda hard to take. You don't have any time to process and once a patient dies you're technically freed up to start seeing more patients immediately.

My calls have been busy. Like I said, I cross-cover the two other services in addition to taking care of my own. Pediatrics is probably the most challenging on cross-cover. Peds is a whole different world. The nurses can be very protective and can pick up on any hint of insecurity or indecision in a fresh intern (am I still fresh at this point?) and can take advantage or make you feel very small. The parents have a knack for wanting a complete update and overview of everything their kid is going through and why at 2 AM and all you know about the kid is his/her name, their allergies, their med list and why they are there.

I'm getting much more efficient at admitting patients. But it is still exhausting. Last overnight call I was admitting a patient a little after midnight and she kept falling asleep mid-sentence. I would gently wake her and she would forget where she left off. By the time I reminded her she would doze off again and we'd be back where we started. Eventually I just gave up talking to her and started my physical exam - which she slept through for the most part.

The catch to our hospital is that, unlike the medicine services at UM, we don't cap for admissions. To clarify for my medicine friends, we admit to three services that cap at ten but also will admit the overflow patients and patients for private docs as well sometimes. And, also different from the academic setting, we admit to all services every day. We did that at Chelsea but Chelsea was a fraction the size of TG. I have no idea what the record is for admission on call but the other weekend I know they had at least 15 admits on Saturday.

Anyway, it's a lot of work, obviously, and I expected as much. I'm looking forward to my next day off (Sept 15th) and my first vacation (early November). And I really look forward to going to bed about right now.

Before I retire - an abstract from an article from a British Medical Journal. It's about surgeons but I think it applies to all residents.

Background Considerable interest and concern have been expressed about junior doctors' hours. This study was carried out to evaluate the emotional and cognitive effects of a weekend on call in a surgical ward.

Methods Ten surgical house officers were assessed, in counterbalanced design, on four Monday mornings, twice after a weekend off duty and twice after a weekend on call. Cognitive functioning was assessed using the Cognitive Drug Research computerized cognitive assessment system, and emotional state was evaluated by means of the Aberdeen Mood Rating Scale.

Results Following a weekend on call, significant impairment in concentration, speed and power was observed, and the doctors felt less confident, less energetic and more confused. Impaired attention, working memory, long-term memory and confusion were most closely correlated with number of hours worked on Sunday, and tiredness and confusion were related to number of hours slept.

Conclusion A weekend on call has significant deleterious effects on cognitive performance and mood. The findings have implications for staffing levels and the design of duty rosters.

Common sense to some, but not realized by many.
Until later...