Calling off sick in Emergency Medicine

[han14tra]

Currently an attending and approaching 9 weeks pregnant. The first trimester has been 24/7 nausea and exhaustion. I'm on unisom and b6, but still feel crappy. I've lost 5lbs. I'm struggling to hydrate and keep getting nosebleeds from vomiting. I have a stretch of single coverage night shifts coming up. My "morning" sickness has been mostly at night. During my last stretch of nights, I vomited on the last night (when I was 5 weeks).

There is no back up at this place. It's me and 2 nurses. No PA, RT, tech, specialty coverage, notta. I'm the only physician in the hospital at night and code team leader. I'm starting to feel like this is a bad idea. My plan is to try to find a colleague who is understanding and will switch me for a non-single coverage shift. If that doesn't work, I'm going to ask my OB what she thinks and use some sick leave if she agrees. Knowing that nights in the first trimester increase the risk of preterm birth, I'm not too keen on working 4 nights in a row. How would you handle this professionally? This is our first pregnancy.

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[RustedFox]

Item number 271 on the list of items that suck about EM: life happens, but you're expected to work for the greedy corporate toads who care about nothing other than capturing those facility fees.

Pay attention, med students. Choose a different specialty.

 

[JacobMcCandles]

There’s two ways to view this and a bunch of different ways to handle this. Are you a business owner or no?

 

[bravotwozero]

Academic jobs will be more accommodating to someone in your situation.

Ben Taub hospital/Baylor exempts docs in late term pregnancies from night shifts at the very least.

 

[han14tra]

There’s two ways to view this and a bunch of different ways to handle this. Are you a business owner or no?

No, and it's not RVU based

 

[thegenius]

Currently an attending and approaching 9 weeks pregnant. The first trimester has been 24/7 nausea and exhaustion. I'm on unisom and b6, but still feel crappy. I've lost 5lbs. I'm struggling to hydrate and keep getting nosebleeds from vomiting. I have a stretch of single coverage night shifts coming up. My "morning" sickness has been mostly at night. During my last stretch of nights, I vomited on the last night (when I was 5 weeks).

There is no back up at this place. It's me and 2 nurses. No PA, RT, tech, specialty coverage, notta. I'm the only physician in the hospital at night and code team leader. I'm starting to feel like this is a bad idea. My plan is to try to find a colleague who is understanding and will switch me for a non-single coverage shift. If that doesn't work, I'm going to ask my OB what she thinks and use some sick leave if she agrees. Knowing that nights in the first trimester increase the risk of preterm birth, I'm not too keen on working 4 nights in a row. How would you handle this professionally? This is our first pregnancy.

I am very largely sympathetic for you due to the nausea / vomiting and feeling ill. 100% I would not work (nights or days) if you think you can't do your job adequately. I would cover for you if I were one of your colleagues.

However...say you had a normal pregnancy thus far and you wanted to not work nights because it increases the risk of preterm birth (I didn't not know that, so I'll take that at face value. What is the exact risk?) Is the expectation that you will not work nights at all while you are pregnant, for the remaining 7 months? Then you'll appropriately take maternity leave. Will you work nights after coming back after a 3-6 month maternity leave?

At the end ER is a 24/7 job and someone has to cover your time off, whether it's sick leave or for pregnancy, or whatever. This can be handled several ways, and most of these ways unfortunately involve you either agreeing to pick up more of these undesirable shifts in the future so everything balances out, or you paying someone to work those undesirable shifts.

 

[dchristismi]

... and if you can't find an out, also know that a helpful nurse, a 20g in the AC and 1L of IVF is the easiest way to quickly hydrate. Many of us have done the same, because of various illness and crappy coverage. I know I have. Just run it in while you're charting.

Carry and sniff alcohol wipes (the literature calls it "aromatherapy" - seriously) for nausea. I don't know how well it actually works for morning sickness, but it helps my migraines in a pinch.

 

[han14tra]

I am very largely sympathetic for you due to the nausea / vomiting and feeling ill. 100% I would not work (nights or days) if you think you can't do your job adequately. I would cover for you if I were one of your colleagues.

However...say you had a normal pregnancy thus far and you wanted to not work nights because it increases the risk of preterm birth (I didn't not know that, so I'll take that at face value. What is the exact risk?) Is the expectation that you will not work nights at all while you are pregnant, for the remaining 7 months? Then you'll appropriately take maternity leave. Will you work nights after coming back after a 3-6 month maternity leave?

At the end ER is a 24/7 job and someone has to cover your time off, whether it's sick leave or for pregnancy, or whatever. This can be handled several ways, and most of these ways unfortunately involve you either agreeing to pick up more of these undesirable shifts in the future so everything balances out, or you paying someone to work those undesirable shifts.

Shift and night work during pregnancy and preterm birth—a cohort study of Swedish health care employees

Previous studies of preterm birth (PTB) concerning night work have been inconclusive and partly limited by imprecise data on working schedules. This study investigated the risk of PTB in relation to detailed, registry-based data on working hours.In a ...

www.ncbi.nlm.nih.gov

I would work night shift after the first trimester and after maternity leave. My only hesitation now is that I don't think I can effectively run a code or do a complex procedure with a nosebleed and head in an emesis bag

 

[miacomet]

Currently an attending and approaching 9 weeks pregnant. The first trimester has been 24/7 nausea and exhaustion. I'm on unisom and b6, but still feel crappy. I've lost 5lbs. I'm struggling to hydrate and keep getting nosebleeds from vomiting. I have a stretch of single coverage night shifts coming up. My "morning" sickness has been mostly at night. During my last stretch of nights, I vomited on the last night (when I was 5 weeks).

There is no back up at this place. It's me and 2 nurses. No PA, RT, tech, specialty coverage, notta. I'm the only physician in the hospital at night and code team leader. I'm starting to feel like this is a bad idea. My plan is to try to find a colleague who is understanding and will switch me for a non-single coverage shift. If that doesn't work, I'm going to ask my OB what she thinks and use some sick leave if she agrees. Knowing that nights in the first trimester increase the risk of preterm birth, I'm not too keen on working 4 nights in a row. How would you handle this professionally? This is our first pregnancy.

If you are sick, you are sick. Call in sick, let them figure it out. Done. I usually agree with @dchristismi but not on this one and I'm surprised she thinks it's your responsibility. Imagine if you miscarried because you worked a shift when you were sick. No one expects you to work with a broken leg, they shouldn't expect you for this.

Are you 1099 or W2? If you are W2, fill out FMLA paperwork for those four days. This is your director's problem, not yours.

 

[thegenius]

Shift and night work during pregnancy and preterm birth—a cohort study of Swedish health care employees

Previous studies of preterm birth (PTB) concerning night work have been inconclusive and partly limited by imprecise data on working schedules. This study investigated the risk of PTB in relation to detailed, registry-based data on working hours.In a ...

www.ncbi.nlm.nih.gov

I would work night shift after the first trimester and after maternity leave. My only hesitation now is that I don't think I can effectively run a code or do a complex procedure with a nosebleed and head in an emesis bag

Yea then you absolutely need to get more healthy before returning to work, or your work needs to make accommodations (whether you're pregnant or not).

I hope you get better soon. I cannot imagine what it's like to have daily nausea and random vomiting for an unpredictable period of time.

 

[CoolDoc1729]

I’m for all intents the sole breadwinner in my family so realistically I couldn’t afford to not work during my four pregnancies. Literally I vomited daily throughout all of mine. Can you afford to take some time off, and pay someone to take these upcoming nights ?
I’m going to put in a plug for icees if you need to keep working, or just in general. There’s something about the cold and the sugar that stays down a little better for some reason.
Hope you feel better soon !

 

[thegenius]

I’m for all intents the sole breadwinner in my family so realistically I couldn’t afford to not work during my four pregnancies. Literally I vomited daily throughout all of mine. Can you afford to take some time off, and pay someone to take these upcoming nights ?
I’m going to put in a plug for icees if you need to keep working, or just in general. There’s something about the cold and the sugar that stays down a little better for some reason.
Hope you feel better soon !

Yikes

 

[PianoMedic]

One of our nurses kept a stack of alcohol pads by her during 1st trimester, she worked nights and also had bad overnight “morning sickness”. I would definitely ask for some assistance with this from others in the group.

Last pregnancy my wife went through severe nausea without vomiting but literally would have such terrible nausea from the smell of various foods she also was dropping weight. It also would occur randomly for her. She was on B6 and doxylamine, also reglan and phenergan. I would discuss other options with your doctor about controlling this, imo you shouldn’t be vomiting so violently you’re getting nosebleeds. If you came to see me in the ED you’d be getting those other meds and maybe even compazine as an option.

 

[cyanide12345678]

Email or call your medical director with your concerns and let him or her know how much you are struggling with hyperemesis. Emphasize your concern about physically being unable to care for patients. Let the medical director figure things out.

Also, it may be time to take some reglan maybe? Probably will be hard to stay awake with reglan and unisom. But oh well.

 

[wareagle726]

Yeah I'm with these people. You are literally doing the most important job on the planet(momming, not ed doc). You have two lives at risk here. I think, depending on your circumstances, seeing if your OB will at least back you on this and maybe even diagnose you with hyperemesis. It would be pretty crappy of your colleagues to not help you out especially with an OB saying baby is at risk. I've covered many shifts for A LOT less.

 

[miacomet]

I’m for all intents the sole breadwinner in my family so realistically I couldn’t afford to not work during my four pregnancies. Literally I vomited daily throughout all of mine. Can you afford to take some time off, and pay someone to take these upcoming nights ?
I’m going to put in a plug for icees if you need to keep working, or just in general. There’s something about the cold and the sugar that stays down a little better for some reason.
Hope you feel better soon !

You didn't have short-term disability?
My jobs have offered STD, and this would def apply. I don't think OP should have to PAY anyone- she's sick. They will get paid for taking the shifts. OP will get STD or not get paid, but I'm not seeing how she should have to pay anyone else. Unless she owns the business, the uncovered shifts are the hospital/director/group's problem; it's not hers to solve.

 

[CoolDoc1729]

You didn't have short-term disability?
My jobs have offered STD, and this would def apply. I don't think OP should have to PAY anyone- she's sick. They will get paid for taking the shifts. OP will get STD or not get paid, but I'm not seeing how she should have to pay anyone else. Unless she owns the business, the uncovered shifts are the hospital/director/group's problem; it's not hers to solve.

We have STD, but it pays like 1/3 of my normal income and they only pay 5 weeks for postpartum. I wasn’t going to take an entire year off due to vomiting- didn’t consider it at all. I wanted to pay off my house and my loans and all that good stuff.

 

[miacomet]

We have STD, but it pays like 1/3 of my normal income and they only pay 5 weeks for postpartum. I wasn’t going to take an entire year off due to vomiting- didn’t consider it at all. I wanted to pay off my house and my loans and all that good stuff.

Ugh, I'm sorry. My last job, for all its failings, had decemt STD and paid for 12 weeks of maternity leave, 16 in a pinch.

 

[TooMuchResearch]

Depends on the job.

We will accommodate any of our docs as much as possible for pregnancy related things, injury, illness etc.

I've also heard of lots of places that will just drop you.

 

[DetroitERDO]

I’m for all intents the sole breadwinner in my family so realistically I couldn’t afford to not work during my four pregnancies. Literally I vomited daily throughout all of mine. Can you afford to take some time off, and pay someone to take these upcoming nights ?
I’m going to put in a plug for icees if you need to keep working, or just in general. There’s something about the cold and the sugar that stays down a little better for some reason.
Hope you feel better soon !

Yes I'm in similar situation, primary breadwinner and had to work during my 2 pregnancies. Agree with this advice about icees and also getting the IV while charting. Also using ginger chews and alcohol swabs.

It will get better after 1st trimester but insomnia and sleepiness will definitely set in again during 3rd trimester so be aware. Welcome to the world of mothering/being an ER doctor. Its a tough and cruel world that's all I can say so just try and get as much rest as you can and rely on your partner and village (friends and family) its gonna be the most rewarding but also most difficult journey you will ever embark on

 

[scummie]

Are we twins? 9 weeks pregnant also, sole bread winner. Me no work, me no get paid. Super frustrating. One of the pros of an academic job. If you can dump the shifts, I would.

I found working nights (and thus less sleep) made my nausea much worse. Nothing like vomiting on shift multiple times. Been popping B6 during the day Q8 and unisom at night to help. Preggie pops and ginger stopped working a long time ago. Graze during your shift. Fruit also helps. Have you thought about adding Zofran or Phenergan? What about Pepcid?

This is an IVF baby, and desperately wanted. Will start weaning off hormonal support which will hopefully help.

Working nights and shift work has been shown to have higher rates of miscarriage or complications in first and third trimesters. I worked in a group that once you started third trimester, there were no more overnights. It was great.

Totally empathize with you. Weeks 9-10 are supposedly the worst for morning sickness. It’s getting better. Soon your placenta will take over. You got this.

Edited to say, you’re replaceable. If they need to, they’ll find a way to fill your shifts. The hospital will not totally self implode Iike the Death Star if they have to fill these shifts in a pinch. Godforbid something happens to you, the hospital will move on without you. So please, prioritize yourself and your little one.

 

[xaelia]

If you need to keep working because it will cause irreparable harm to your family's financial situation, then it'll come down to humane negotiations with your director/group.

If you can afford to drop the shifts, then call out sick. Don't normalize self-injury and self-harm to be a cog in an uncaring machine.

 

[Brigade4Radiant]

You should feel no guilt about calling out sick. You already lost the money for the shift.

 

[xaelia]

It just bears ceaseless repeating: the "why is burnout so high" answer to our specialty is that we've normalized and brainwashed ourselves into a culture of self-sacrifice and self-harm.

Every time you work while sick, you tip the needle away from allowing someone else to take time off while sick. It's not heroic, it perpetuates systemic workforce abuse.