Last Call

By last call I don’t mean the last call for alcohol before a bar closes; those nights are long behind me fortunately, way back to my college days.  No, by last call I mean the very last time I would receive phone calls about patients by nurses at the hospital, from 5 pm to 8 am the following morning.  This night I was responsible for about eighty patients, and apropos for the last time I would be on call, it was a doozy. 

The phone rang its signature jingle, the screen lighting up the dark hotel room, pulling me out of a deep dream sleep.  “Hello, it’s Dr. Brooke,” I said after I swiped the bar on my cell.

“Sorry to wake you Dr. Burke,” replies a female voice.  My New Englander Vermont accent silences my rrrr’s, so it always sounds like I’m saying Dr. Burke.  I’m too tired to correct her as I try to find the on-switch of my analytical brain.

An Indian voice starts to tell me something about a patient, and I can only make out every four or five words due to her thick accent and my not-yet-fully-awake consciousness. 

“347-1…had a…with the…he’s…” she quickly informs me.  

“Ok, hold on, hold one, what’s the patient’s name?” I ask, turning on the bedside lamp and searching for my reading glasses, the pen, and scrap of paper I kept on the bedside table for these nighttime calls.  

The name of the patient was important to me, not just to solidify the information so that I could pass it on to the daytime doctor, but also because patients are people, not room numbers.  All the nurses, during the day and night, refer to their patients by room numbers, and often I could hear the chatter at the nursing stations.  “Did you get the blood pressure of 428-2?”  “213-1 is discharging today.”  “523-2 needs to go down to x-ray.”  "I need helping placing an IV in 208-1." This dehumanization was hard to hear all week during the day, and it was now heightened in the middle of the night.  What if I wrote down the wrong room number? It was much safer to get the name of the patient.

A few seconds later the nurse finds the patient’s name, and I relay back to her what she had told me: “Ok so Mr. John in room 347-1 had a witnessed fall and he’s ok.” 

There was a brief pause, and then she corrected me. “No, no, no fall, it’s just that the computer…sepsis…alert…vitals…blood count…”  she adds, and I’m not understanding any better than the first time around.

It took her repeating the information several times and me asking her to slow down before I understood she was advising me a patient had a fast heart rate and his labs from earlier that morning showed low white blood cell counts.  In the right context this could be a sign of immune system depression and impending severe illness, but the patient was comfortable, without any complaints.  She was calling me because it was protocol to do so when the computer had prompted her with a pop-up box alert.  After getting more information about the reason for Mr. John’s admission to the hospital, as well as his previous heart rates and blood counts, I reassured her that this could be followed up on in the morning.  I hung up, snapped off the light, dropped my head back onto the pillow, and immediately fell back asleep.

The phone rings again—I’m not sure how many minutes or hours later—and I click on the light again, answer the call, relieved it was a different nurse who was easier to understand. 

“Hello, it’s Dr. Brooke,” I said.

“Sorry to bother you Doctor, but 156-2 is refusing to take his bowel medications,” she reports.

I pause to take this in.  “He doesn’t want to take his bowel medications?” I ask.

“Yes, Doctor,” she replies.

“Well, what do you think I can do about that while in my hotel room?” I respond with a sleep deprived edge to my voice. 

“Oh, I’m…I’m not sure…” she trails off, sensing my irritation.  

“He has a right to refuse his medications,” I tell her, then adding with a sigh, “When did he last have a bowel movement?”  I was starting to feel guilty about being snarky; after all she was only doing her job.

 “It’s been six days Doctor,” she replies. 

“Well tell him he’s at risk for his colon rupturing if he doesn’t take them, which will lead to an abdominal infection and possible death,” I say, “And I’ll see him tomorrow to talk with him about it.” 

“Ok, Doctor, thank you,” she answers, though I’m sure she’s not thankful after how I responded to her.

This time after I hang up, I am unable to go back to sleep.  I was irritated to be called for something I could do nothing about, irritated that my sleep was interrupted, irritated that I had been on call by then for seven days.  I was ready for call to be done and wanted more consecutive hours of sleep.  I am one of those people that function best at on a least seven hours of uninterrupted sleep.  Any less and my brain is foggy the following day.  Hence, the reason, among many others, that I did not choose to be a surgeon or an obstetrician.

Unfortunately, many more calls trickled in that night, and the list next to my bed grew longer, names and rooms numbers, brief notes about what was going on: patients with very high blood sugars needing insulin dosing, high blood pressures needing more medications, chest pain complaints needing send out to the emergency room, and yes, a patient with a real fall out of bed, though thankfully without any injuries.  I got through it the best I could, with snips of sleep in between, and was so relieved when it was time to get up at 5:30 am, after which the calls slowed down.  I’m too old for this, I thought to myself as I got into the hot shower to try and wake myself up.  The entire week I felt like I was in internship or residency, and there was no way I ever wanted to go back to that crazy schedule. 

With elation the following night, I realized that not only was that the last call on this locum assignment, but the next assignment in Wisconsin would also not have any call.  And even better, neither would the full-time job I accepted in Alaska.  No more interrupted sleep.  No more working weekends and twelve days in a row.  No more abuse on my physical body and mental health.  The days of my experiencing burnout were long over, and I was ready to start the final chapter of my professional life as a physician.  Balance.  Sleep.  Time for self-care.  Who knew this was even possible in a career in medicine?