Let's Get Intensive

Back on call again. Still sucks.

I've realized, though, that for those whose only impression of "call" comes from Gray's Anatomy and Scrubs, being on call is a hazy, ill-defined concept, and reality's blurred. My repeat assertions that "it sucks" have surprisingly done little to clarify the matter. The truth is, aside from the casual sexual encounters with coworkers, there is not much in common between the real world and the world of make believe. As an example, an average call in the Medical Intensive Care Unit (MICU):

• 0530, Wake up, realize it's a call day, grimace.
• 0600 - 0630, Drive to the hospital in silence. This is likely the happiest I'll be all day today.
  
• 0630 - 0635, Arrive at the hospital and change into scrubs that I have found and scavenged throughout the hospital on previous non call days. Sometimes they fit, sometimes they're stained, sometimes there're huge unexplainable holes in 'em.
• 0635 - 0830, Begin pre-rounding on my old patients. Pre-rounding consists of recording a slew of vital signs, lab values, consult information, nursing reports, radiographic data, drip rates, machine settings, and then, finally, talking to the patient for 5 minutes. Thankfully many ICU patients are on ventilators and do not have much to say.
  
• 0830 - 1200, Round with staff and fellows. Staff rounding consists of telling the staff physicians about everything I have just collected and then politely nodding while my co-interns do the same.
  
• 1200 - 1215, Run the board with the resident. Basically we find a big marker board and cover it with little check boxes of the things we have to do today.
  
• 1215 - 1230, Get lunch at the cafeteria to go. As the food choices are often some sort of fish, often pollock -- whatever the hell that is, and some odd mix of sides that do not go together I frequently find myself eating a lot of grilled cheese sandwiches. It turns out BAMC has the best grilled cheese sandwiches.
• 1230 - 1600, Work. Write notes, write orders, record more information, and repeat. Sometimes I accidently find myself talking to my patients which only puts off all the work I have to do.
  
• 1600 - 1700, Take sign outs. Around this time, while I am still going about my regular business, various other interns page me to come check out their patients for the night's cross cover. This is when I get to add more little boxes to all the previous boxes I had already checked off for the day.
  
• 1700 - 1730, T-cons and emails. If there's a lull in the work and we have not already had to admit any new patients, I just may get to take care of the other, non-ICU, work that builds up 24/7 year round. T-cons are things I need to call my outpatients back about and emails are typically incomprehensible military things I need to delete or poorly characterized tasks I have to take care of somehow, somewhere.
  
• 1730 - 1745, More sign outs.
• 1745 - 1130, Admit patients. Nightly we receive anywhere from 0 - 5 new patients from the ED. Typically it's around 1 - 3. Each individual patient seems to take me about 2 hours to fully work up, admit, and write a History and Physical (H&P) on. I would say I am slow but I honestly do not know how to go about it much faster without cutting corners. Or at least more corners than I am already comfortable cutting.
  
• 1745 - 2330, Cross cover. At the same time I'm admitting patients I also gotta take care of all those pesky check boxes!
  
• 2330 - 2350, Dinner. Hunger pains and hypoglycemia force me to momentarily stop or slow what I am doing to eat. Thankfully there're usually other things that can also simultaneously be done while eating. Like checking boxes for example.
  
• 2350 - 0200, More admits and cross cover.
  
• 0200 - 0205, Think about sleeping, but then do more admits and cross cover.
  
• 0205 - 0245, Take care of a crazy patient. Inevitably someone will completely lose their mind over the course of an evening and I get to try and persuade them not to. It seems restraints and tranquilizers are not in fashion these days.*
  
• 0245 - 0250, Think about sleep again, but then do more admits and cross cover. Maybe watch part of a show in an unconscious patient's room.
  
• 0250 - 0345, Code Blue. Someone is dying and it's my job to stop it! Or at least delay it for another few days or weeks till it inevitably comes about.
  
• 0345 - 0545, Admit again.
• 0545 - 0700, Finish whatever needs finishing, and pre-round on my old patients if there's time. Sometimes I eat a yogurt cup.
  
• 0700 - 0830, Check out with the CCU (Cardiac Care Unit) team. This is when I learn that despite working continuously for > 24 hours straight it just isn't good enough.
  
• 0830 - 1100, Check out with the MICU team and staff. This is when I learn that because I worked continuously for > 24 hours straight it's clear I did my best. Good game everybody, good game.
  
• 1100 - 1230, Finish whatever needs finishing again. Complete notes, complete H&Ps, and sometimes fall asleep at or on my keyboard.
• 1230 - 1231, Leave the hospital. My reward? The sensation that someone has thrown sand into my eyeballs. Whether cloudy or sunny, wet or dry, walking to my car is always a mildly stinging experience.
  
• 1231 - 1300, Drive home with music blaring and singing along. This is likely the happiest I'll be all day today.
  
• 1300 - 1530, Eat, shower, and go to bed.
  

Total time awake: 33 hours

Friggin' miserable.

In international news, President Bush. Guy can dodge bullets. Or at the very least well thrown shoes from close range. And Prime Minister al-Maliki? Way to step in where the Secret Service was not. Batting away gun shots -- err shoes -- with greatest of ease. I know I don't have moves as smooth as that. Would have taken both shoes square on the nose, back to back. No country would take us seriously afterward. Really, though, it seems global politics is going more and more the way of Austin Powers these days.

"Who throws a shoe? Honestly! You fight like a woman!"

In domestic news, we've got Christmas lights!



Almost looks respectable from this angle!



This angle not so much. It turns out I did not quite measure the required length of lighting very well. But, uh, it's the thought that counts?

*Not to suggest that they should be. Restraints and tranquilizers should only be used when absolutely necessary. Like when the patient has made you angry.