As a medical student, one of the big bad bogeymen you hear about that ruins every resident's life is the call shift. The concept of being on call is based around a shrunken medical team that is supposed to hold down the fort until the full team arrives for the next day's/night's work. You're not supposed to advance the care plan, but just monitor, tinker, and keep them alive if things go sideways. Sprinkled into call shifts are "consults," which is the process of seeing a patient and determining if they are going to be admitted onto your ward. This is most often done in the Emergency Department, but at times you may transfer a patient from another part of the hospital and "take the consult" by going to see them and evaluating them.
Each country has a different call shift culture, and each territory (and even each hospital within those territories) organizes their call schedules in unique ways. Some doctors work a call shift that has them stay 5-6 hours after their colleagues go home in the evening, long enough to "hand over" to a nighttime staff. A shift like this can reach up to 16 hours. Others will do "night float," which in effect is the night time staff previously mentioned, who will do 1-2 weeks of just night shifts. These shifts are about 12 hours long. Some doctors are on call every moment of an entire week, but can go home in the evenings and have to come back in only for emergencies or very ill patients (this is usually reserved for senior staff). I work in a system where a call shift simply tacks on 16 hours to your 10-hour day, and you stay overnight until your team arrives the next morning; essentially, 8 AM to 10 AM the next day.
This particular system is controversial, and many hospitals have moved away from it to some of the other structures mentioned above. The research is murky, but it is a prime focus of the medical community at the moment. Go to PubMed (a medical research database) and search "work hour". 10,133 results as this posting, of which most discuss time spent at work. In 1980, 45 articles were published that involved these terms in their manuscript; in 2020, that number was 558 on August 1st.
The hours are hard, and they take a toll on a young doctor; I can now attest to this. But time spent working is not what scares residents the most about call shifts; it's the Code Blue, an in-hospital medical emergency in which the patient has suffered a cardiac or pulmonary arrest. Most involve CPR; many involve intubating the patient; some even involve defibrillation, which some people identify as the moment McDreamy yells "CLEAR" and an electrical shock to the chest causes the patient to do The Worm in their hospital bed.
As a first year resident, you are bound to get called to Code Blues, but overnight Code Blues significantly increase the likelihood you're going to get directly involved. My first daytime Code Blue was to the Labour and Delivery ward; by the time I arrived, four separate medical teams were already in the room: Obstetrics Team, Pediatrics Team, Intensive Care Unit Team, Code Blue Team (of which I was a member). I gowned up, and did sweet fuck all as I stood off to the side and let the other 30 people already there take care of this poor woman. This is common for first year residents attending daytime codes.
My second Code Blue was overnight, during one of my first call shifts. This blessed night was quiet. The ward patients were happily sleeping with no complaints or emergencies. The Emergency Department was also quiet, which meant I had received just one consult. I snuck off to the call room at 2:00 AM to grab what I was hoping would be a two hour nap. How naive and stupid I was three weeks ago. I carefully rested my personal pager, my team's pager, and the Code Blue pager across my chest, right next to my full-volume-alarm-is-set cell phone so I.would.not.miss any alerts that I was needed. It was a go-fuck-yourself waiting to happen.
45 minutes later, after my eyelids had gently closed..... BEEEEEEEEEEEEEEEEP-BEEEEEEEEEEEEEEEEP-BEEEEEEEEEEEEEEEEEEE-----I jolted upright with an ab crunch violent enough to shit myself. And I heard the announcement over the PA system directing me to the building, floor, and room of where the Code Blue was called.
If you've ever missed your alarm the morning of something important, you know the feeling I had waking up at that moment. It is that same sinking feeling in your stomach, but instead of thinking "omigosh I'm going to die" it's more like "shit, they're going to die."
This time, I was early enough to get in the room. The patient had a pulse (so no CPR yet), but her pupils were blown wide open and she had no gag reflex, all really bad signs. I waited as my senior directed the code team, while my other first year colleagues went through her medical history and continually checked for pulses. I stood ready, but motionless.
It really is a mind-altering experience; you zone-in... every detail, sound, and sight of the case registers. You are calm, (because what else are you going to fucking pretend to be?). But internally, a bad orchestra is playing a worse melody in your head, chest, and bowels. Then before you know it, your senior is saying "no pulse, okay you're doing chest compressions" and pointing right at you. What is there to do but approach the bed, link your hands the way they taught you, and start? I swear to Hippocrates I had two thoughts the moment I started CPR:
Don't be scared, compress around two inches. And
Go to the tune of Stayin' Alive, the way they taught you, but NOT the way they did it in The Office.
I can't tell you why my mind went to the absurd in that particular moment, but something we did worked because her pulse returned. I exhaled after what seemed like minutes of holding my breath, and before the air stopped flowing out of my nostrils, we lost her pulse again. Another 60 seconds of compressions, and we were informed by another staff member the patient's family didn't want us to keep trying. She was gone.
That room had seven people in it, and only two of us were in our first month of training. The rest were seasoned veterans, and yet, there was a moment --one solitary moment-- where everything and everyone froze after we were told to cease efforts. It felt like I made eye contact with every person in that room at once, only our eyes visible over face masks, all behind clear plastic face shields. It felt like we had a funeral for her in that one moment. It felt like a few of us shouted in our minds "NO, let us keep trying!" Suddenly I was reading everyone's mind, or eyes, I don't know. It felt like everyone was paralyzed as the hand of God rebooted our systems so we could get on with our shifts. Wipe memory. Upgrade processor. We weren't the same robots after that experience as we were before. I know I wasn't.
We walked slowly back to our wards, idle small talk flowing. We were three first-year residents and a student, ready to act normal. But it wasn't normal. The energy was like that moment in a movie right before the jump scare, but it stretched on interminably. And then my colleague's pager went off like a knife to the ear drum. The message was relayed that one of her patients was feeling short of breath, and requested she check on them. I asked if she wanted company. Her eyes said "yes" before she said the words, because how can you be alone when someone just died at your finger tips? This is what it looks like when doctors try to make each other feel better, I guess.
Two hours later, I updated the day team on the night's events and handed over the patient list. Thirty minutes after that I was walking to Tim Horton's for an Ice Cap, crying behind my sunglasses at the end of a 26-hour shift. Moments later, I stepped out of the elevator and into my apartment. One for the books. Another data point for the ol' processor. You can only become a good doctor if these nights become data points; data leads to conclusions, and the more of them, the better the conclusions. That woman is dead, and I am smarter for it. Twisted.
Oh yeah, we were talking about call shifts. Long hours are hard too, I guess.
It's a data point. You can only become a doctor if this becomes a data point.