How I survive on-calls
Perhaps one of the most dreaded transitions about moving from a medical student to a practising doctor is the prospect of starting on-call shifts. There is the perception amongst many that this is when you are most exposed, almost isolated, with a huge amount of pressure to manage patients. This was certainly what I was most concerned about, and they have indeed turned out to be some of the more difficult shifts that I’ve worked so far. Whilst most of what I’ve been called for has been fairly routine, it is true that people can become very sick, very quickly, and there is always a little bit of anxiety that the next call will be an urgent request for help with a deteriorating patient.
As I mentioned, thankfully these calls are few and far between, but at times things do mount up, and for me, this is when I really notice stress building. I remember one particular occasion when I was called to see a septic patient by the nurse who had noticed a drop in blood pressure. The gentleman was ill and of course it took time to stabilise him. Whilst doing so I received two further calls, one of which was to speak to the family of a patient who was thought to be approaching the end of his life, and another for a lady with type 2 respiratory failure with a ward-based ceiling of care who had deteriorated further. I escalated the situation, making sure my seniors were aware of all the patients.
When I had done what I could with the first, I moved on to find that both of the other patients had passed away. Given that the deaths were both expected, I knew that there was nothing more I could have done. However, that’s often very little comfort, and there is always a feeling of ‘what if’. What if I had seen to those patients first? What if I had dealt with things more efficiently? What if I had escalated earlier? In times like this, it’s important to remember that you are only one person, and that you can only deal with one problem at a time.
When it comes to making an on-call shift a little less stressful, the advice is fairly generic, especially given the unpredictable nature of the job. As with everything, I think preparation is important