30 hour call nights

Greetings from hour 17 of my 30 hour call night. These happen every four days and I am nearing the end of week 2. So far, our team has been spared busy nights *knock on wood here* and have managed to sleep a few hours each time. We may have been able to sleep a lot more, if only we had known that we were not to get patients to admit. Instead, each hour is spent trying not to get too relaxed and trying not to dread the possibility of getting slammed with new admits.

30 hours of call is an interesting experience. You leave home often before the sun rises and you return at noon the following day. Between that time, you round twice with your team, watch other teams' patients, try to read, try not to jinx the team by wishing for/against admits, and you do a lot of waiting. I used to start the day off with a soda and keep caffeinating from there, ready at all times for things to get busy. When they never did, I'd be stuck aimlessly watching TV for hours - too tired to read, too caffeinated to sleep. I've learned since then to actually drink a lot less caffeine on my call nights, and to sleep whenever the opportunity arose.

The ICU rotation is going well. It is another world here, one that I don't think many people can really fathom. Our patients are, by definition, critically ill. Many have been here for weeks, stuck in the limbo of life and death, often (and fortunately) too sick or sedated to be conscious of it. Then there are the family members at bedsides: children, spouses, and siblings who are often forced to interupt their grieving process to make remarkably difficult decisions about their loved one's care. Meanwhile, the nurses have learned to remain jovial and sensitive at once, and know their patients better than anyone else. The rest of us - "the medical team"- we travel en mass, between 7:30 and 10:30 am every day to stand at the patients' bedsides, discussing their care, often revealing our ignorance, and turning what is possibly the most emotional and significant time of our patients' lives into our classroom time.

There is a certain futility in many of these days, mixed with ample intellectual masterbation. We review our physics and pathophysiology, discussing patient A's ventilatory pattern as he passses slowly from this world. Every day, a critically ill patient or two significantly improves and is sent off to the floor, but most of these people have underlying terminal cancers or chronic diseases that might bring them back to us in a month or two. Strangely, one of the most noble pursuits we currently have is to make one of our patients well enough so that she make it home to die from her cancer there.

It's 11:30 pm. Nearly time for "midnight rounds". This is an attempt we make every night to see our patients and their nurses at midnight, allowing us to get a few hours of quiet time before having to get up for morning prerounds. Of course, this hasn't worked out well so far, as all our admits so far ahve come during these early morning hours.