Last week, I had my first night on call. All day I sat at home with anxiety about the night ahead of me. I knew I had to go into the hospital at 7pm and could leave at 11 am the next day. Anything that happened overnight was my responsibility. Of course, I would have senior residents to help me, but I would hold the pager and everything would come to me first.
In preparation for my night on call, I spent the day napping, got in a good workout, and went to the grocery store. It’s kind of like a mini-day-off since you don’t have to go in until 7pm, but I did want to try to get some additional sleep during the day.
I ended up going to the hospital early, around 6:30 because I had no idea what I was doing and I wanted plenty of time. My co-resident Carl was on day call, so he would sign out the service to me. That means, he would tell me a little about each patient and tell me what I needed to do for them overnight. It was also his responsibility to forewarn me if he anticipated anything bad happening with one of the patients. We call this, “anticipatory guidance”. For example, you might say “this patient did well today, but if he spikes a fever overnight, this is what we think is going on so you should start this antibiotic and discontinue his central line” or “this patient had a seizure today- if he seizes again tonight, try giving 1 mg of Ativan but if that doesn’t work you can give 2 mg.”
At 7pm he handed me the pager, and left.
I was all alone.
So, I went around to each patient and introduced myself. “Hi, I’m Andrea, the resident physician on the neurology team. I’m here for the night, so if there is anything you need just let me know.”
Then, I went around to each nurse taking care of my patient and introduced myself. “Hi, I’m Andrea the intern on for the night. Do you need anything for Mr./Mrs. so and so?” I would also ask them their names and write it down next to each patient so I knew which nurse was taking care of which patient. I also updated the nurse with whatever anticipatory guidance I had been given about the patient. “I understand Mr. M gets a little confused at night. Try talking to him first and calling me. If he’s really agitated we can give him some Seroquel.”
By 8 pm I was done with that, so I went back to the room and started to read a little bit.
By 9:30, nothing had happened and I hadn’t gotten one single page. I decided to go check on everyone again.
I went around to check on all the patients (I think I had 7 total patients that night) and everyone was tucked in and doing well. I told the nurses one last time to call me if they needed anything.
With great hesitation, I left the unit and went up to the call rooms. I didn’t feel super tired, but nothing was going on and I figured I should try to get some sleep if I could. Who knew what the night would hold.
There are individual call rooms for all the teams at the hospital. They are on the seventh floor down a long, dark hallway, in a part of the hospital that no one could find even if they were looking for it! It’s kind of creepy. I found my room and got settled in.
For the rest of the night, I tossed and turned. I felt such anxiety that my pager wasn’t going off. I was sure I was missing calls! I kept checking in on my patients from the computer and making sure we hadn’t had any new admissions. Nothing.
Finally, around 1 or 2 am, I drifted off to sleep.
I didn’t get a page until 5:30 the next morning. Boy was I relieved to finally get a page! I know I shouldn’t want to have my sleep interrupted, but it was SO unnerving to not have any calls! During the day, my pager goes off NON-STOP, and I was expecting the same thing over night!
The day team comes in around 6:30-7am so after my 5:30 page, I went down to get some coffee and I started to write my morning notes.
I left the hospital around 10:30 and came home, not tired at all! I was hungry though. The entire night was SO stressful for me. Even though I didn’t get a single call, it was the anticipation of something catastrophic happening that kept a pit in my stomach all night. The only thing that sounded good to me was a grilled cheese. Not the healthiest choice, but I made one and enjoyed every comforting bite 🙂
After that, I ran a few errands before taking nap in the afternoon. I really wanted frozen yogurt (can you tell I like to eat when I’m stressed?) but I convinced myself that I didn’t need it after I had already had a grilled cheese. So, I bought a Kevita instead. Have you ever had a Kevita? I LOVE them! They are sweet and have a tiny bit of fiz, a little tang, mmmm so good!
Also, they are super expensive- like $3.50 a bottle, so I buy them as a treat or when I’m talking myself out of an unhealthy choice. Since they’re just as expensive as frozen yogurt, it’s a good substitute 🙂
So that was my uneventful night! I’m laughing at myself now that I was so nervous about nothing. But, it was a good start and I know I will be grateful for any night that my pager stays quiet!
Have you ever not been able to sleep because of anticipation?
Are you ever worried because something isn’t going wrong? I kept waiting for 10 admissions all at once and was so anxious that nothing happened!