Maturity

What makes a "bad" call shift?

When I was a first year resident, I would lie awake in my narrow bunk, praying that nobody would page me. Any night that I didn't make a decision was a good one.

Last night, I got called twice between midnight and 7am. This is unprecedented, especially for ICU call. The calls I got involved simple medication changes (labetolol, I love you) and clarification of nursing orders. I never got out of bed. At one point I thought, "This is weird. Maybe I should get up and check if everything's ok". But then I reassured myself that my phone and pager were both on and working, and pulled the covers tighter.

As it turns out, I was right to be suspicious. The junior resident HAD received a call, a consultation from ER. He had seen the patient, made some decisions about treatment and done admission orders. All of this would be fine, but he had done it without making a diagnosis. He approached the patient with a shotgun of drugs, all for different causes of respiratory failure, and gave them all.

I went over his decision making with him this morning.

Me: So. You had very sick patient, the ER gave you a terrible handover and didn't tell you why they had intubated him, you were unsure of the diagnosis and you didn't call me. Why?
R1: I wanted to manage the patient on my own.
Me: But you were worried about them and didn't know what to do. In that case, you are supposed to call for help. If not me, then the staff.
R1: But I want to manage patients on my own.
Me: (murder eyes burning through his skull) But. You. Are. Not. Qualified. For. That. You are a junior resident who is supposed to be operating as part of a team, in a teaching hospital that spells out clear rules for when to seek help.
R1: I wanted to manage him on my own. And...I thought you might want to sleep???

Now that I am a senior resident, I want to be making decisions. I want the R1's to call me and tell me what they're thinking. I am comfortable making choices at 3am that affect patient outcomes. I am happier to be sleep deprived and thinking all night than sleeping in the call room.

I guess this is growing up?

As a side note, I also did a kick-ass thoracentesis and took a litre of fluid off an old dude's chest, allowing him to breathe without oxygen for the first time in weeks. It wasn't a totally terrible night.