Last week I took overnight call for the first time as Orthopaedic resident and its was…exciting. It was exciting not only because it was my first call, but because Hurricane Irene was also bearing down on the East Coast, ready to bear all sorts of carnage. On the drive in to work, I saw this in my neighborhood:
Of course since I was driving in at night (I took this on my post-call day) I almost hit that tree, not expecting it in the streets of Baltimore. But this was only the continuation of my “exciting” call since when I woke up on my call day I had no power due to the hurricane showing Baltimore Gas & Electric who’s boss.
I finally arrived at the hospital, and at that time I got sign out from all the services, Trauma, Spine, Peds, Hand, and Sports. They all gave me their pagers, and I was left to fend for myself. Okay, just kidding, they also left a PGY-4 from Union Memorial to help me through my first call too, but it didn’t change the terror I felt of having 5 pagers on my waist. At around 5:30 pm all the pagers began to go off. Its a known fact that you get the bulk of your pages about floor patients around the time that nurses are getting ready to switch off. By 10 pm many of the patients started to go to sleep, so the pages that started coming in then were ER consults, because everyone with a fracture decides to wait until Friday night around 11 pm to come in to the ER.
The night was pretty eventful and the one thing I noticed immediately that was different from being a medical student on call was that the option of sleeping just wasn’t there. Often as a medical student when things started to slow down at around 2 a.m. the resident would tell me to get some rest. I wrongly assumed that the resident himself/herself were also heading to their call room for some shut eye. But this just is not possible; when you are not getting paged about floor patients to come change Mr. X’s IV pain med to PO, or that Mrs. X started to get tachycardic and is complaining of 10/10 pain; and when you are not getting paged by the Adult or Peds ED to see such and such patient who they have been sitting on for like 3 hours before they call you, then you are typing up all the consults that are required to be done before 6 am the next day when the attending comes in to round on the new consults. In addition to that, you also have to present all the consults you saw at “The Board”. The Board is where the resident on call pulls up all the X-rays of the consults they saw in the ER or on the floor and describes the fracture/problem, and shows how they fixed it/splinted it, etc, and what the overall plan is. You are doing this in front of all the residents and a couple of key attendings. Most times this can be a stressful but benign event, however if your splint looks sub-par on X-ray, or you missed something important on X-ray, or you are asked a pertinent question about the fracture classification and don’t know it then the event can get particularly stressful. As a new intern, really just 2 weeks into being in the hospital, on my first call, I had to make sure that I had my presentations for The Board down pact.
So really all this equates to the fact that you just can not sleep at all when you are on call for ortho at Hopkins. There is too much to prepare for even when the ED isn’t harassing you. However this was the aspect of the program that I really liked as a student. I liked the fact that even though its an academic institution, you work very hard. Its better to put in the hard work now than suffer and stumble through things later as an attending.
I’m writing this currently after finishing my second call as an ortho resident and it was even more busy. Although I must say that I did learn a bunch; I learned how to put on a spica cast, I learned how to evaluate a deep laceration of the forearm for tendon and muscle damage; I put on a sugar tong splint and ulnar gutter splint without supervision, which is truly the only way to know that you do or don’t know how to put one on correctly; I learned how to deal with patients calling the on-call pager for pain scripts or cast care, etc. There truly is so much new information to learn in the field of orthopedics and I’m excited to even get the chance to do this. I’ve still be struggling with having devotion during this ortho rotation, but I know that at some point I have to make it a priority over other stuff I do in my limited downtime.