my on-call diary

My first experience of a 24 hour call was in the Medicine clerckship. We are actually not required to stay beyond 10:00 pm, but that was not my luck on that tuesday. As a medical student I usually get the first admissions. However, that night the specialist on-call had something else in mind; He wanted me to present a case the next morning. And so far none of the admissions were "interesting" enough.

It was nearing 10:00 pm. And I was getting frustrated; If I get a patient now in my current sleep-deprived state it will take me around three hours to fully work him up, check their old file back to back and write a full history and physical. Moreover, this is was the last month so
studying for the shelf was at the back of my mind. But again the specialist insisted I wait...

As I lay in the residents room trying to catch some few moments of sleep, my bleeper goes off...it's 10:35 pm. On the other side I hear the nurse saying it's case of "PUO". Too groggy to care what that meant, I got a quick cup of coffee and headed to the nurse's station. I learn that it's a case of a 16 year old who's been having fever and joint pain the past 8 months. Every labratory work up has been negative;it's a case of pyrexia of unknown origin (PUO). I felt like I was working on a "Dr. House" case. The differential is anything from infection to malignancy. And this boy has been through alot. I knew that taking a thorough history and physical was the most important step. Five minutes into the interview and as the caffeine started to kick in, I realized how lucky I was to be handling such a case.

The hours passed quickly, I had no motivation to go back home. I had to be here early in the morning anyways, so I stayed up. Reviewed the case over and over again, as I skimmed through uptodate resources. I slept a couple of hours woke up again for morning report. I never felt more awake. I was filled with some sense of acomplishment. However, I could never compare this to real on-call situation where you normally cover and round on several patients.

Currently I'm rotating in Ob/Gyn and the calls are even crazier on this side of Hamad. I've just finished rounding with my resident on 40 patients! Not one patient was like the next; 29 weeks coming in labour, patient having triplets with threatened abortion, pre-eclampsia for induction, a misdiagnosed hyperemesis gravidarum...etc. Just when you think there couldn't be anymore patients the pager proves you wrong! And then of course there are always the patients that will need repeated evaluation, possible evacuation or C-section. Really Ob/Gyn doctors deserve great respect for the amount of pressure and work they put up with.

The day after the post-call day is usually the worst for me. On the post-call day I am too damaged to feel the physical "pain". It's like having a third degree burn when you no longer can feel the pain because of all the damaged nerve endings. The day after my body wakes up to tremendous physical & mental exhaustion.

Now third year is coming to a close and in a month's time we will be starting the sub-Is. It will be a true test of how well I handle the calls when given the full responsibility. I hope my experience will be rewarding, with all the pain, exhaustion that is part of the package.