#on-call

Back when I worked overnight on-call, on-site at the inn, we'd occasionally have new front desk people who'd get hired for AM shift and-- just think they could pester me.

Keep in mind, I was going to bed on an average of 6am.

They'd call me when I'm sleeping, 8am, 11am, anytime just for the Dumbest rubbish. "Hey, I forgot how to do this in the system, can you walk me through--"

At first, I was patient. "Here's how, but I'm not on-call in the day, you need to call a manager. I'm sleeping."

With one girl, it happened probably SIX times. Just CONSTANTLY waking me up, and even calling me on the emergency landline to do so for just system/training questions. I told management, she'd been talked to, but it just kept happening.

So, finally, one night, I waited until about 3am, then called her on her mobile. "Hey, I was just wondering when you worked today, did you-- Oh, I'm sorry, were you sleeping? I just assumed you were awake Just Because I Was. :>"

She stopped calling me after that.

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- inserted my first 3-way catheter (and also first female catheter since med school)

- learnt how to reduce a paraphimosis

- learnt how to do bladder washouts 

- diagnosed and initially managed renal stones

- was first on the scene to a guy with a large GI bleed and helped to stabilise him

It depends on the on-call, and whether you’re ward cover or admitting patients. For my long days at the moment I only cover urology admissions until 5pm (since there’ll be other doctors on all the wards until then), then from 5-8pm I cover 5 - urology, colorectal, upper GI, vascular, and a short stay ward post-surgery. But sometimes there’ll be outliers on other wards. 

Tomorrow I actually only cover urology + urology admissions, because they have a ward cover F1 for the rest of the surgical wards on the weekends, woop. 

I think in a way nothing can really prepare you for them and you mostly learn by doing it and experience - this is true for a lot of aspects of FY1 imo. 

But depending on the on call, there are definitely some things I can do to prepare and at least put my mind at ease and feel like I’ve done something. Tomorrow I start my UAU on calls, which is the urology unit. I’ve done basically no urology since qualifying, so I’ve gone over the most common urology presentations and how to assess them - urinary retention, renal stones, blah blah. As an F1 you’ll always have a senior around and usually the surgeons will make most of the decisions, but I think it’s important to at least have somewhat of an idea of whats going on. We’re the ones who usually clerk in the patients so I’ll have to make a stab at a diagnosis and get things rolling before a senior sees to them.

Similarly for the general surgical admissions unit, I’ve gone over a few of the most common and important presentations, like cholecystitis, pancreatitis, bowel obstruction etc. 

And I don’t mean go over them like you would as if you’re revising for an exam. I just want to refresh the main symptoms, what to look out for, and what tests to order pretty much. As an F1 I don’t need to know the pathophysiology of pancreatitis or really rare stuff, I need to know the basics. 

For nights though, I have no idea. Think I’m just gonna have to roll with it and see what happens.

In terms of other preparation, I have been very relaxed and had 8 hours sleep every night the past few days, have had lots of chill time and also socialised. I want to be well-rested before I start! Very important.

It depends on the on call really! You can do on calls in the day, also. The only on call I’ve done so far was a weekend shift and basically, the main difference was that I was covering a lot more patients than usual (over 100), because you cover all of the surgical patients rather than just your surgical specialty. And rather than having a whole team, it’s just you, an SHO and a registrar. So you’re more likely to be on your own doing things, and you’re also more likely to do more hands on stuff and see sick patients because there’s so many patients, so there’s a bigger chance something will go wrong. You’re definitely more rushed and busy. Oh, and they’re longer days - 12.5 hours usually. 

I haven’t done nights yet but from my boyfriend’s experience it’s similar for nights - you’re more independent, covering a lot of patients, and very busy. You’ll rush from ward to ward doing whatever’s most urgent, whereas often on a normal ward day you’ll be sitting in the office for hours at a time doing admin. From what he tells me it seems the most common jobs he gets called to on nights is to see ‘scoring’ patients - patients who have unstable or falling observations, like blood pressure - to review them, and also prescribing medications. You also usually carry the crash bleep on nights, so if there’s a cardiac arrest you get called to that.