I know that it has been quite literally 6 months since I “put some ink” on my blog, as one of my friends puts it. I have been so busy doing some major ADJUSTING to my new schedule and my life as not a med student but a newly minted doctor, New Jerseyan, and apparently adult. It has been so hard but so good and so rewarding and I will have to write about that in another post.

Anyway, I thought that I would write this post to discuss one of the rotations that I have completed already this year. I’ve actually done it twice by the time that I am writing and editing this post because I was one of the fortunate people to have a whole month of it in my intern year. I wanted to talk about this one both to provide some encouragement and so people can see what I did wrong and maybe make better decisions. Enjoy!

My intern year (first year of being a resident) began at night. I came into orientation that glorious morning and got my pager (an indestructible device resembling a small brick that rings when people want to contact you, for you generation Z people). Then I went home, took a nap, and showed up bright and early for my 7 pm shift.

Teams came in and began giving me the signouts for their patients. In other words, they gave me the pertinent information that would help me (or not) when I got paged for their patients. I took them all, attentively listening to the stories for all the patients because they were all so unfamiliar and interesting. At the end, I was drowning in lists of patients from all the medicine teams.

After all the teams left and it was just me and my two senior residents who were busy admitting new patients, reality and panic set in.

Me: Wait a minute, how do I log into the computer? Which team was I supposed to order a CT scan for again? *PAGE* Where is the bathroom? Where can I find this patient? *PAGE* How do I even order things? What blood pressure do I need to treat overnight?? *PAGE* Do I need to call the fellow on this patient? *PAGE* Am I hungry or just anxious? Are those fireworks outside? *PAGE* *PAGE* *PAGE*

My nights were crazy but I can honestly say that there were some things that I did to try and make logical decisions at 3 am.

 

Get organized early

At the beginning of each shift, before any of the teams came in, I would have a blank sheet that I would label “To Do” on one side and “Pages” on the next.

The to-do side would have labs that I needed to follow up on, the patient’s name, medical record number (MRN), and the patient’s team. This really helped me because I would just go through the whole list of things for follow up anytime I was at a computer and because all of the MRNs were there, I could run through them quickly.

The pages side of my sheet held the number that paged me, which patient it was for, and the problem that they were having along with what team they were on. This was so helpful because I could just call back the number without having to guess which one was for which patient. Also, it just helped me stay on top of my pages.

The learning point here is that you need a system. The first night I didn’t have a system in place yet. It was a mess. I’ll just leave it at that.

Go see the patient.

I first heard this when I was in medical school and it is something I have taken with me into residency. Frequently a patient will have abnormal vital signs or an abnormal symptom that requires evaluation. These patients, after I got a page I would put a red “I” with a circle around it to remind me to go see that patient. I had to go “lay eyes on them”, if you will. This gave me time to think about what I needed to possibly do for this patient and time to text my seniors if it was someone who was potentially decompensating. This leads me to…

Your seniors are here to help you!

No, they are here to admit patients. However, if you need help, don’t hesitate to ask them. There were some times that I really just didn’t know what to do from lack of experience (I was a medical student like yesterday!!), and other times, a patient’s symptoms were really concerning and I needed them to help me with the next steps to evaluate a patient overnight. Each time I needed their help, they were extremely gracious toward me because it was my first time being a real doctor and trying to make decisions.

 

Now, for the practical, non clinical stuff

 

Eat now, ask questions later

So night float was a funny beast, in that I wanted to eat at normal times at first, but couldn’t because my stomach was confused. I would get really hungry in the middle of the night when nothing was open, and when I would bring a large meal, my stomach was still confused because it isn’t used to eating oxtail, rice and peas, cabbage and a large drink at 3 am (I realize I am probably the only one with this problem). Anyway, I had to eat at some point. What I ended up doing that helped was eating small meals during my shift and a small meal when I woke up around 3 pm. I was able to eat in small portions much better than larger ones. I still ended up losing some weight on night float, but I wasn’t a hangry person during my shifts.

Stay connected

One of the hardest things about night float is the isolation. I think this was the one that I had the hardest time getting around. Honestly, I didn’t see Rome for almost a week when I was working for my last week. Plus, when you are awake and want to talk to all your family and friends, they don’t answer, because it is literally 3 am and apparently calling working people during that time isn’t polite. *rolls eyes*

Some things I did to combat this was facetimeing when I had my awake and not at work times. So when I first got into the house in the morning and Rome was at work, I would facetime him briefly and talk to him about my night and whatnot. I would call my mom when I woke up from my nap, and call my friends when I got to work, etc. I would work around my schedule, per usual. Telling everyone that I had a crazy schedule at the time helped so much too because people understood that I wasn’t ignoring them, I was just hibernating.

Don’t be unpleasant

It is easy to complain about how you’re tired, how you’re hungry, how the vending machine doesn’t have the special doritos that you like. If you do this, however, you’re forgetting that you have 2 other people who also are going through the same things that you are. Bringing up how uncomfortable you are won’t make you feel better, if anything it will make you even more upset. This is not the way to happiness and success, my friends.

Instead, try to be a light. Don’t be another grumbling, complaining person. It won’t help anyone.

Take a Walk

There is a blissful time between 3 and 5 am that the patients who were in pain in the beginning of the night have finally fallen asleep and no one is checking vitals in order to call you about hypertension. This is the time that I found myself in the basement of the hospital, walking laps. At first, the staff down there thought I was crazy, and eventually those same people were looking for the doctor in all purple to go down to the basement and walk a couple of laps.

It was a fabulous thing to do for my stress level and for my step counts. I did this every night that I had a free moment and I would always make a deal with myself and say that I would only stay down there until I got the next page (the blessed pager works in the basement). I would sometimes have 5 minutes before *BEEP BEEP BEEP* would sound and I think one time I had a full 30 mins. Either way, whether it’s 5 or 30, the effect was still the same.

 

I know I’ve been MIA, and thank you for showing me grace while I figure out my ever changing schedule. I’ll try to be posting once every two weeks or so as my schedule and my sanity allow.

 

Love you guys,

Lise