First Night On Call!

[gwen]

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Soooooooo, how was your first night on call? I'm curious to see how other interns felt about their first call ever!

 

[Surfer75]

eWWWWWWWWWW... don't ask... I started on Wed, call on Thursday, then Sat-Sun, and Tuesday upcoming... this is hell! I know for sure I don't want to do GI 🙂

JT

 

[Stormreaver]

Good ole' GI: **** and spit!

 

[Annette]

Because we have a lot of rotators, my first night on call isn't until the 11th. Considering how my fellow interns are looking post call, I'm not in a hurry. The night float people look absolutely dead, and the ICU intern is at risk of coding!

I'm starting out on an elective, and I still am reconsidering my career choice.

 

[UTSouthwestern]

I remember my first call night as an internal medicine resident . . . On call for the MICU on the freakin first night. Took EIGHT hits that night working with a resident who needed to take ephedrine to get one level above comatose. Five legitimate ICU players of the eight, three of which coded that evening. My learning curve and aging process took a great leap that night. Four MI's (two unstable), massive GI bleed, acetominophen overdose, diazepam overdose, and hyperosmolar, non-ketotic coma.

I am so glad those days are behind me.

 

[Rigomortis]

Originally posted by UTSouthwestern
I remember my first call night as an internal medicine resident . . . On call for the MICU on the freakin first night. Took EIGHT hits that night working with a resident who needed to take ephedrine to get one level above comatose. Five legitimate ICU players of the eight, three of which coded that evening. My learning curve and aging process took a great leap that night. Four MI's (two unstable), massive GI bleed, acetominophen overdose, diazepam overdose, and hyperosmolar, non-ketotic coma.

I am so glad those days are behind me.

Oh yea, can't wait for that Parkland MICU!!!

 

[task]

I just came off Parkland MICU (last block as a second year resident). I was in the last group to do 6 weeks of q3 call -- ahh, the 15 calls went by in a snap 😛 (right)

The q4 for one month a block will definitely make the Parkland MICU a different experience. That and the fact that now once someone leaves the Unit, they go to (aka get dumped on) a floor service.

At any rate, no other experience in any other Medicine residency compares with being the Parkland MICU resident. Great stuff.

 

[Future GI Guy]

I've had my first three nights of call, and they (knock on wood) haven't been that bad. My last night, Monday, was the worst so far, and besides trying to admit three patients while taking check-out, there wasn't that much of a frenzy.

Luckily, I don't get called too much at night, and when I do, it's generally something I can handle over the phone.

The most annoying thing that happens, and I guess this happens everywhere, is that when the nurse disagrees with my plan, she calls my senior resident, who tells her to do exactly what I told her to do. This is the most irritating part of cross-cover (for me, anyway), but I guess it'll continue to happen until they trust us more.

As for when I do have to go see the patients, it's usually chest pain which has resolved or someone trying to leave AMA so they can catch the bars before they close. Nothing that an EKG and some Ativan can't handle.

I got called for Dyspnea once, and subsequently found that the patient had turned off his Oxygen while keeping the nasal prongs on. I was very happy with that page, I can tell you.

I guess the most important things I've learned so far are the following:

1. Check the simple stuff first (is the O2 turned on?)
2. Always be nice to the nurses, even when the questions seem silly.
3. Always tell the nurses what you're thinking when you do something and DON'T ask what their opinion is, unless you're clueless.
4. Always be nice to the nurses. (It's important enough to state twice).
5. A good senior resident won't care when your question is dumb, and I've had plenty. Reassurance can be more valuable than anything.

 

[Apollyon]

My first month (last year), I was day float, so that was bad enough.

I just recall the night I was on call and got paged 52 - that's right, 52 - times.

The very last call, in June, the nurse lacked so much confidence, she called the attending who is always in-house, and HE paged me at 4:45. I told him what I told the nurse - the pt's CK is 162000. He needs 1500cc/hr + 2 amps NaCO3.

And, of course, that was a cross-cover! Nothing like not knowing a damn thing about the patients you're covering ("Everyone's fine, no one's sick. There's noone who's DNR, but noone is going to die tonight.").

 

[gwen]

why did you say that you shouldn't ask the nurse for an opinion? my calls so far have gone decently...and i do ask the nurse what s/he is thinking. many of them have 30 yrs of experience, which surely beats my two weeks of residency. it never hurts to ask them what they think and of course to use your own brain in the end.

 

[DrWBD]

I had my first overnight call for Telemetry last Friday.

The pager just wouldn't stop going off until about 4:00 in the morning, when I had to scramble to catch up with all the post-cath checks and follow-up labs I hadn't gotten to yet.

But I survived, and I'm doing it again tomorrow 😀

 

[Future GI Guy]

Gwen,

I don't totally disagree with you, and i do have profound respect for those nurses who've been working for thirty years.

It's the fresh-out-of-college nurses, the ones who give Vicodin (i.e. Tylenol) to my neutropenic patients when I specifically write orders to the contrary...those are the nurses whose opinion I'd rather not know.

As you know, you don't want to hide a fever in a patient with 10 neuts. You'd like to know if something is brewing. There's nothing quite like finding your "afebrile" neutropenic in septic shock, all because the nurse didn't see the utility of switching to Hydrocodone (which I wrote for) from Vicodin, which seemed to control this patient's pain. In that instance, and in many others, I haven't particularly valued those opinions.

Looking back, I'm sure that this particular mistake was made because the nurse didn't know what I was thinking or why I made a switch. I should have communicated better with her, and perhaps that would have saved this patient a trip to the unit.

That said, when I work in the MICU, you can bet your bottom dollar I'll be asking those nurses what the hell they think. I've never met a group of more dedicated professionals than ICU nurses, and they ALWAYS know what's going on.

I guess it just depends on who your working with, and as you pointed out, how many years experience they have.

 

[UTSouthwestern]

Rigor, I'm already done with my medicine residency. Going back to Parkland MICU would be a choice I do not want to and will not make. Will miss the excitement, not the paperwork though.

task, you'll miss some of the experiences with the new schedule. Hopefully things will get worked out. I had a long discussion with Foster about that a few months ago.

 

[gwen]

ordered my first restraints for a patient who wanted to go out for a smoke at 3:00 in the freakin morning and was so combative, intentionally falling off the bed to get attention and disrupting the whole floor by yelling and screaming! it was a crazy night!!!

 

[Ligament]

I'll give all you new interns a very valuable tidbit of advice, called the "B-52."

5 of Haldol and 2 of ativan, will take care of your most troublesome patients.

enjoy!

Ligament, enjoying home call!