Fighting Fatigue on-call and post-call

Hi all,
I am rapidly coming to the close of an Acting Internship in General Surgery at INOVA Fairfax. Working while tired is a way of life on this rotation. I have really adjusted to this schedule and I have learned to make the most of short rest periods.

My day starts at 3 am when I get up, showered, dogs walked while I get in a 20-minute run. I live about 15 minutes fromt the hospital so I am usually at the hospital by 4am. The first thing I do is check the board in the OR and get dibs on the best cases. I like to do cases where I can learn new techniques or rare cases like a Whipple procedure for the experience. The gastric by-pass operations are cool too. I am usually on the ward by 4:30am where I check my patient’s labs, vitals, overnight problems etc. I then see each patient, do a focused physical exam and write notes. I generally have eight to 10 patients to pre-round and write notes on. I then meet my team: senior resident, intern and me. We then round on the patients making addendems to my notes and co-signing my orders. We discuss the plans for the day for each patient. We then go to conference which is usually at 7am (free breakfast!) and then to the OR for the early cases. I usually spend from 8am to about 2pm in the OR. If there is a conference at noon, I will break out for the conference. I then do afternoon rounds on my patients and try to speak with the attendings on patient care. Our team does afternoon/evening rounds and we leave or stay. If I am on call, I check the OR board for late cases to scrub in on. I am also on call to scrub for exploratory laps on trauma cases. I am required to respond to the Code Yellow and Code Blue traumas that fly in by chopper or come in by ground. You can expect to get at least 8 to 10 of these overnight. I then follow up on all radiology procedures on my patients and any patients that are signed out to me. I usually late round on the surgical floors to write post operative notes on any patients who have operated on that day and take care of any nurse’s concerns before I head to the call room to put my feet up. There is no sleep because of the trauma patients. I can usually get a nap or two. One night, I actually slept for 2 hours, woke up paranoid that my beeper wasn’t functioning, only to find that the hospital was on fly-by because we were out of ICU beds! Couldn’t sleep after that adrenalin rush! As 4am comes around again, I am checking the OR board and then pre-rounding on my patients. On post-call days, I might get out by 3pm if the board is quiet. Trauma call ends at 5am so we can get our pre-rounds done.

I wear T.E.D. hose (knee hi) at all times and support hose under the T.E.Ds. I operate in heavy plastic clogs because running shoes are not comfortable to stand in. Since my feet often get bloody in the OR, the heavy plastic clogs wash out in antiseptic and autoclave easily. I do not wear clogs on the wards. On the wards, I wear my running shoes. I keep my running shoes on top of my locker in the surgery call room. I wear scrubs at all times and put a lab coat or OR jacket over top when I come out of surgery. I operate in angel frame eye shields to protect my eyes or goggles. I wear loupes for vascular work and a headlight if I am going to be deep in the thoracic or abdominal cavity.

I take Tylenol if my feet hurt and I try to get them up if I am resting. I do at least 20 crunches for my abs so my back doesn’t hurt. I drink at least 2 cups of coffee on call; one in the early morning and one in the late afternoon. I drink water the rest of the time. I have soup for lunch and dinner so that heavy food (fries and burgers will make you zonked) doesn’t make me sleepy.

I keep the call room at least 75 degrees so I am not fighting to keep warm. If you get too cold, you get stiff and you get sore. I also rest in a overstuffed chair as opposed to getting in bed.

When I am overtired, I try to drink water. Dehydration makes you cranky and irritable. That’s why I avoid caffeine. Too much sugar gives you a bottom out. I also step out onto the roof or outside the ER for a breath of fresh air that has not gone through the HVAC system.

Don’t forget to call the family and tell the significant other that you love them. The busier the on-call night, the faster the time flies. You do get used to working without sleep and you can learn to nap efficiently. Finally, make an effort to be nice to everyone and apologize if you are too cranky post call.

(Edited by njbmd at 7:23 pm on Jan. 20, 2002)

Post of the week! Great synopsis of what is necessary Nat. I am sure Mary is reading this or has already taking notes…

I agree, this is an excellent post! When do you sleep? How many days a week does this happen?!?


Quote: from njbmd on 9:54 am on Jan. 20, 2002
My day starts at 3 am when I get up, showered, dogs walked while I get in a 20-minute run. I live about 15 minutes fromt the hospital so I am usually at the hospital by 4am.
(Edited by njbmd at 7:23 pm on Jan. 20, 2002)

how on earth do you get up, dressed #1, walk dogs/run, shower, dress #2 and out of the house in 45 mins?

I've been trying to do the same routine for several weeks and can't make it out in less than an hour - sometimes more

How often does this schedule happen?
On-call is Q3day so you are basically post call, good day, on-call.
How do I shower, run/walk dogs in 45 minutes?
I wear scrubs, no make-up and hair wet in scrunchie. I think I am what is known as a “ultra-low maintenance” woman.