I may be a mean, nasty person when I am not on call, too, but I have no insight into that. :)
On this call weekend, however, I am well aware of the edge to my voice, the tension in my whole body, the force with which I am typing notes, and my aching head. I am acutely aware, and I feel really, really bad, about taking some of this anger out on my kids.
So I’m taking a half an hour to vent about it.
While this call has not been “busy” in the sense of a long inpatient rounding list, nor “busy” in terms of numbers of phone calls, it has been “heavy” in both medically complicated, unclear, and/or logistically challenging inpatient cases as well as a number of… difficult patient phone calls.
The inpatient issues: I discharged a patient Friday, who came right back into the hospital the next day. This is a supreme no-no. It’s called a “bounceback”, or re-admit, and I get scrutinized/ criticized for it, as presumably, I sent the patient home before they were really ready to be discharged, and this is costly to the hospital and insurance company, and bad for the patient. Now, I know that I felt very comfortable sending them home, and that this plan was corroborated by another attending; and I know the patient wanted to go home. But no matter, it’s now a bit of a mess, and I look (and feel) like a jerk.
I admitted another patient who was very ill, but the cause was a bit of a mystery. After spending literally hours analyzing the labs and studies, and reading up in the textbooks like I was a medical student, doing a huge long writeup, and having a discussion with the patient and the team about what I thought was going on, it looks like I was wrong. She will be fine, but again, it’s a bit of a mess, and I look (and feel) like a jerk.
The outpatient issues: There were many long, convoluted phone calls requiring alot of my time and listening skills, as I was pretty much helpless in all cases. 20 minutes talking one patient down from a panic attack. Several 30 minute-plus calls listening to long angry rants about the perception of poor care received in 1. a local ED and 2. a local nursing home. Endless discussion about why one narcotic wasn’t working and a new prescription for another narcotic is now necessary. Logistical messes sorting out administration snafus- I kept getting erroneously assigned to patients on another service. Then also sorting out when one of our patients was assigned to the wrong service. Just alot of headachey stuff.
So I was here at the hospital all day yesterday, much longer than I anticipated. I was stuck here as the pager kept going off and I simply couldn’t get up from the damn chair on the nurses’ station. The beeping and alarming, the lights, the noise, the constant crises make me crazy. The pages were making me crazy.
Then I got stuck in a traffic jam on the way home, and was paged in the car several times, requiring me to fiddle with the pager and the cell phone, hoping that the police didn’t pull me over; and then I was late to relieve the babysitter.
I was paged at home as soon as I got home, and while I was trying to pay attention to Babyboy, and even trying to make cookies with him (his favorite mom-time activity), I was obviously distracted. And it was a long, difficult phone call about narcotics, and I was getting pissed.
So was Babyboy, and he showed it by shoving Babygirl, and then sitting on her. Now, he is 2.5 yrs old and not too heavy, but she is a petite little 13 month baby and he squished her. So now I am trying to manage this phone call and get him off of her and soothe her.
I got the lady off the phone and of course, the pager goes off again. Babyboy, undeterred by my forceful admonition, started giggling and picked up a pile of Legos, throwing them down onto our lazy fat cat, who had made the mistake of relaxing amongst the toddlers.
I again grabbed Babyboy, tried to get him to look me in the eyes, and said “No! No! Kitty Ouchy!”
He again giggled and again took up an armful of toys and threw them down onto the cat, who is not too bright, really, and had only relocated a few short feet away.
Now I had Babygirl crying, Babyboy apparently determined to hurt the cat, and the pager going off. Again.
Babyboy grabbed another handful of Legos and ran towards the cat, ignoring my yelling, giggling even. So I overreacted. I slapped Babyboy. Just with the tips of my fingers, but enough to sting, I’m sure. And he cried.
Now I looked, felt, and WAS a jerk.
Babyboy put his hand up to his cheek, crying, and then, heartbreakingly, he came over and held his arms up for a hug from me, crying, “Mommy, Mommy!”
I hugged him and held him and said, Oh, I am so sorry, mommy is so sorry. I meant it.
And I called my mom. Compounding this whole situation, Hubby has been traveling, so I was on overnight Babygirl duty Friday, and she was up her usual 3 times… I’m tired.
Mom came over to help out so I could answer phone calls. The calls stopped. The kids calmed down. We played Legos. I talked about it with her, and later with Hubby.
I know I lost my temper in the moment, but it is not Okay. I know that the strain of call and the fatigue were the background factors for me to lose control, but they’re not the direct reason, nor the excuse.
Call sucks. Medicine is hard. That’s why not everybody gets to do it. It’s a privelege and an honor, but it’s not for everyone.
My immediate plan is to THANK GOD that Hubby got home late last night. He was up with Babygirl several times last night so I could catch up on sleep. I talked out my bad behavior with him and my mom, and I’ll be on best behavior henceforth, as they are now watching this along with me. I feel like I am being held accountable to better parenting.
At work, I am trying to NOT get emotionally worked up about the inpatient problems or difficult phone calls. I am asking a colleague to take over my inpatient rounding for future calls, so I don’t have to cover the inpatient side ever again (our practice is moving towards hospitalist coverage anyways). I need to admit that it’s just too much, and though it feels nice at times to be prancing around this great hospital in my white coat, and though my patients like to see me, it’s not fair to them or my family. It’s just too much and I can’t manage it anymore.
But the phone calls will continue. I plan to block my clinic this week to be as light as possible, and though that will put me behind in ‘productivity’, it will have to be. And I plan to cut back on my clinic hours on a permanent basis, as soon as this is financially feasible.
I would love to say that I will exercise more, and do yoga, and get therapy. Ha! With all my free time! Not. I’ll pet the cats more is what I’ll do.
And I will try very hard NOT to be a mean, nasty person… on call.