Saturday, June 27, 2009

Let's Start At The Very Beginning...

So, Sunday night, I will be working as a doctor for the first time! I am starting with a two-week rotation called "night float." I'll be covering the medicine service (adult patients in the hospital) overnight, from Sunday through Thursday nights. That means I will come in at 6 PM, talk to the daytime residents about the patients, and then handle all the nursing calls about existing patients and also  admit new patients that come to the hospital during the night. I will have a senior resident (a second year, this time) working with me, which is very, very excellent. I can sleep if people stop coming and/or calling, but I'm not sure how often that will happen. 

Then at 7 AM, I will meet up with the daytime residents again, tell them what happened overnight, and then leave. That evening, I will report back to the hospital 10 hours after I left (so, sometime between 5:30 and 6) and repeat.

Why 10 hours later, you ask? Well, there are 4 main rules regarding "duty hours" for residents:

1. Residents cannot work more than 80 hours per week, averaged over a 4 week period. (A decade ago, 120 hour weeks were often the norm, especially in surgical programs)

2. Residents must have at least 10 hours free of clinical duties in between shifts

3. Residents must have at least 1 day (24 hours) in 7 free from clinical duties, averaged over a 4 week period

4. Shifts cannot exceed 24 hours, though those 24 hours can then be followed by 6 more hours for education, transferring patients, outpatient clinic, or continuity of care. (For example, on our combined obstetrics and pediatrics service, I will sometimes come in at 6 AM, work for the day, then stay to cover the overnight until 6 AM the following morning, and then spend 6 AM to noon continuing to round on the patients on OB and peds or seeing my own outpatient continuity patients in clinic. I have to leave the hospital by noon on those days because that's when 30 hours is up. (Call like that cannot happen more often than every third night, but that frequency is rare in my, as you can see, you'd burn through your 80 hours for the week pretty quickly that way.)

These rules are mainly to protect you, the public, from exhausted doctors. There's a move afoot to limit them further, such as to 60 hours per week, but I think then that residencies would all need to be lengthened a year or two. Now that I have a baby, this is a trade-off I think I would be willing to make! I must say, though, that I think my program does the best it can to organize our schedules in a humane way. 

After my 2 weeks of night float, I do 4 weeks of sports medicine, which is office based and thus 8-5 or so. During that time, I will take overnight call on the OB/Peds service (called Maternal Child Health or MCH at our hospital) once or twice a week, and cover the Medicine floor sometimes on the weekends. After that, I start my first really intense rotation, with 6 weeks as one of the daytime interns on the medicine service. 

We're hoping Brynna does OK over the next couple of weeks. She is not taking bottles at daycare, so she eats lots of solids during the day, then nurses when I pick her up after work and several times through the night. We have no idea if she will take a bottle (or sippy cup) of breastmilk at night when I am at work, or not, but if not, it could create some long nights for Alex. 

Our current plan is that I will take the handoff from Alex when I get home from the hospital in the morning, and nurse Brynna and play with her for a little while. Then I'll take her to Miss A's and come back home and get some sleep myself. When I'm done sleeping, I'll pick B up again to nurse and hang out, and then depending on Alex's work schedule, either hand her off straight to him in the evening, or take her back to Miss A's for a little while until Alex can pick her up. 

As you can see, Alex and I are pretty much not going to see each other for more than a few minutes during these 5-night cycles. I do have the weekend off in between, though!

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