Saturday, April 28, 2007

2 Weeks Post Call and Whiny

(I know I've posted a similar whine in the past, but humor me, this is on my mind.) Yes, it is just as it sounds, I have been on call, 24/7, for the last 19 days. Granted, I haven't been in the hospital/office the whole time, but it takes such a mental toll! Call as a private practice doc isn't anything like call when I was a resident. In residency, being "on call" means being in the hospital for 24 hours (and, prior to the 80 hour restrictions, up to 36 hours) at a time, working with a team of other residents/attendings, and caring for multiple patients, including surgical, laboring, antepartum, and post-partum. It was grueling, but the time was finite. Even on the worst of days, there was a definite time when I could turn the pager off, and take time only for myself. On days that I was not on call, I was generally out of the hospital around 5-6 pm, with no fear of having to return to the hospital until the following morning, as another resident team was shouldering the workload.

Now when I am on call, it is all me, and only me, on call for all of the patients that I have ever seen, and, over the weekends, on call for all of OtherDoc's patients, as well. Most of the time the calls I get can be handled from home with a phone call, and I can go about the rest of my day. Of course for deliveries and surgical emergencies, I need to be in the hospital ASAP. The hardest thing for me is that I can never quite mentally disengage, as at any time, I have to be ready to race to the hospital. I can't ever go further away than 30 minutes from the hospital, and if I am doing something with my family, we often take separate cars, "just in case" I get called. The pager can go off at any time, and you just never know what is going to be on the other end of the line.

When I was looking for positions post-residency, this was not what I had in mind. I was somewhat mislead into believing that call was split Q 3, and weekend call was to be every third weekend. What actually happened was that I was on solo call for a whole year until I could beg, cajole, and finally convince OtherDoc to at least split weekend calls. The other hospital OB has no interest in sharing call whatsoever, and only wants call coverage for vacations. Now there are some perks for being on call so frequently. I do get to deliver most of my own patients, and when I get calls for problems, I know my patients' histories and personalities fairly well, and can advise them accordingly. I also have fewer patients to cover than a group OB would, so that means less trips to the hospital/phone calls/ etc. while on call. I think that in the next 2-3 years the hospital is looking to hire another OB/GYN, and I am desperately hoping that this person wants more of a life and will go for sharing weekend call, and possibly sharing weekday call, as well. As CindyLou and the Bean grow up, I want to be available for sport games, recitals, and school activities without fear of having to leave to the hospital. I knew what I was getting into as an OB/GYN, and honestly, I don't mind being on call for my patients, because I know that they need me and trust me. I just need to strike a better balance of being available, mentally and physically, to my family and friends as much as I am for my patients.

I am now 27 and 2/7 weeks pregnant, and I am starting to physically slow down. Some days I feel just like a little old lady, whining about my "sciatica." Ha! I am rather short in stature, so the belly is quite "out there" and it is already inviting "due any day now" comments, which is maddening. My office has actually started to pare my schedule, and now, instead of 40-50 patients on my full days, I am averaging closer to 30-35 patients on a full day. This is infinitely more manageable, especially when it comes to charting, but now that I am moving slower and a little more tired it still takes all I have to get through those full days in clinic. My "half-days" are still averaging upwards of 20-28 patients, which is also difficult, but so far I am making it work.

It's funny (read kinda sad), because my patients are always commenting that it must be "so much easier" for me to be empathetic to my pregnant patients, as I am pregnant, myself. I am finding the exact opposite. It is hard for me to commiserate with the patients angling for time off work, complaining about common discomforts, and lounging about muttering about how *tired* they feel. Some days it takes all that I have not to tell them to "suck it up and deal!" It isn't a fair attitude to have, because I *do* know how miserable pregnancy can be, and misery is relative. Just because I feel like I am *more* miserable than they, doesn't mean that my patient isn't experiencing more misery than she ever has before. I do find it interesting that the majority of my patients that are having an "easy" pregnancy do not work, and those that are having the most complications are the working mothers.

For now I am going to close this post, because the whining is starting to annoy *me* so I know it must be most unpleasant for all 6 of *you* still checking back to see if I am still alive. I have some really good cases to discuss as soon as appropriate time has lapsed, so I will try to get around to updating in less than 2 weeks time. Happy weekend to all!


MentalMom said...

Looking forward to the rundown on the interesting cases.

Don't worry about the whine, and I think it would be normal to be a little irritated by patients complaints right now. Normally, two pregnant women talking do one of two things: a) commiserate (which wouldn't be very professional to go into much detail on your part) or b) compete (which would be REALLY unprofessional). No one wants to admit it but 'one-upping' is a chronic problem women have and pregnant women are the WORST. Everyone does it at least once in a while and many don't even realize it. When JimmyLou talks about how she threw up 5 times a day someone invariably says either 'I NEVER threw up, I have an iron stomach, my mother said morning sickness is a sign of weakness' OR 'I threw up 10!! times a day, needed Zofran and made three trips to the hospital for IV's"...

Since commiserating and comparing aren't really appropriate for you in the professional setting all that is left is for you to nod and get irritated because you can't say what you would really like to.

Midwife with a Knife said...

Welcome back to the land of the living! :) I've always heard that your sanity in Ob is directly proportional to the number of docs in your call pool.

Funny Story: We had a nice continuity practice in residency. I had a friend who, at the time, was about 39 weeks pregnant (wanted to work until she delivered to maximize maternity time). Anyway, our continuity patients always wanted notes for work (you know, "Ms. X doesn't have to work because she's pregnant." kind of notes). She always told her patients that they couldn't go out of work until she did. It was actually hillarious!

jmb said...

I can't imagine how you manage to do all that you do and then to be on call 24/7 for 19 days straight seems undoable. You are entitled to rant about it. You must have a very supportive family.
Tkae care of yourself and the Bean
jmb, one of the six.

CNH said...

I found your blog last week and I am completely hooked. Why is this strange? Because I am a natural birth junkie and just had my baby at home unassisted 4 months ago! And yet, your writing fascinates me, even though we don't agree on all aspects of birth. I am gaining so much insight from your writing. Thanks!

Anonymous said...


I hope you feel better soon.

Mo (from NZ)

Judy said...

When you're whining we know you're not admitted and on a mag sulfate or terbutaline drip -- so whining is not as unwelcome as you might think.

Maggie Rosethorn said...

Oh, go on and whine. I know I did, as an ob nurse. Sciatica is the pits, and going through pregnancy totally exhausted all the time is tough for all the Whoos. Glad to know the office is starting to pare down your work load.

I am amazed at all the call you do. I know solo practitioners who do less than you do, and all the hospital groups shared call fully q#in group.

Yeah, I know about being short and showing, too. At 25 weeks, I had all kinds of people stopping to ask if the baby was due soon, then, when told I had months to go, was asked if I was SURE I didn't have twins in there, if my dates were right, etc, etc. Oh, well....

Good luck with the rest of the pregnancy, and keep posting.

Ottoette said...

Good to see your post. Amen to all of it. I'm 32 wks 2 days and I could OUT-WHINE you any time! :-) Yes, I work full-time and I also commute 1 hour each way and have the cold/lingering cough from hell. Tra-la-la!
I like "bean" but also still like "Little Dude Whoo".

Anonymous said...

I have not given up on you--I posted a month or so ago, claiming yours as my new favorite blog (Leah, of the velamentous cord situation, if you recall.) Anyway, I'm 29 weeks along with my little nameless fellow and I am apparently carrying right out there big time too because I can't go anywhere without hearing those annoying comments. I love to hear "My, you're big for July!" and "When are you due? This month?" Sigh. I find myself longing for the days of old-fashioned seclusion, when women just went into confinement during their last months. I really do. I can almost manage it, except for having to grocery shop and pick up my little boy from school (whereupon the onslaught of comments begins.)

Like you, I had only gained 10 pounds at my last appointment and was measuring right on schedule, so I don't know what makes me look so extraordinarily pregnant. I'm 5'5". It's just the way I'm built, I guess. (I mean, I can, with terrible posture make myself look 4 months pregnant even when I'm not.)

As far as the misery factor goes, I feel for you, having to go to work and be so relentlessly on call, but I also envy that you a job interesting enough to help keep your mind off your own discomforts. I don't work outside the home, and though my pregnancy has been easy up until now, I could no doubt start to wallow in the increasing misery unless I force my mind into other channels. That's my way of "sucking it up", I guess.

Thanks too for the distraction of your blog. Hang in there.

Anonymous said...

Yes please post more than every two weeks or months! ;)

I can relate to you about the call all alone in a very disproportionate way! I have considerably less to deal with than you. I was pregnant and working a birth center with my last baby and the last thing I wanted to deal with was a pregnant woman! :P I wanted someone to fawn over me...

I'll pray to the gods of ob-jin they send another one for you so you can have a day off ;)

Anonymous said...

I am sending a link to my column online. I really feel medical staff did the best they could do for me, Kansas law didn't give any guidelines, and I didn't ask for what I wanted. My doctor was very compassionate, as were all nurses but one.

Jawndoejah (Dawn)