Tuesday, September 14, 2010

on page, part 3

calmer seas
i started my week on call yesterday. this is only my fourth week of carrying the pager overnight since i started in july, but i am already feeling SO much better about everything [on page and on page part 2 corroborate my progress]. of course, it's still no picnic to be woken up during the various phases of the sleep cycle . . .

those early-in-the-night awakenings from the deepest phase of slow-wave sleep really are trippy sometimes

but -- at this point i am much better at formulating a safe plan for the most common patient calls.

common questions + associated response:
"the insulin pump site failed." give a shot of fast-acting insulin and change the site (yes, even if you already did!). call me again if ketones developing or worse.

"no wait, i think the pump might actually be BROKEN." no problem -- sounds like you need some lantus! let me call your nearest all-night pharmacy.

here it comes to save the day night!

"my kid has ketones and is throwing up." that is bad. if this just started and he still looks okay/would be up for trying to drink, you have one hour to turn things around with a shot and some fluid. if not, high-tail it to your local ER.

i actually never watched this show. much like real-life emergencies + traumas, it never piqued my interest!

"my kid has adrenal insufficiency and is throwing up." also bad. if it was just a little bit and it was following overzealous consumption of dinner at cook out, you can begin by just watching them for a little while. if they look sick or vomiting is persistent, they have earned themselves a shot of solu-cortef and an all-expenses paid trip to your local ER. i'll give them a heads up that you're coming. maybe you'll be lucky and run into this guy!

"my kid is having trouble breathing." for real? and you called her endocrinologist!?!? as you know, breathing is essential. please seek some in-person help!

"i am in college and i ran out of my thyroid medicine." thank you for waking me up at 2 am to tell me about that. i would be happy to call you in some more thyroid medicine -- in the morning.

see? not so hard. of course, there are certainly scenarios that don't fit the above or that require more experience than i have to handle. but i have an attending backing me up each night, and that is exactly what they are there for.

i am really trying to handle the calls and pages i receive in a relaxed manner, and so far this strategy seems to be working! it really is more pleasant to go through the day this way.

tab talk: i know i mentioned writing another tab page this morning, but honestly i think those posts are best reserved for weekend mornings when i can devote a solid chunk of time! rushing = not my style, and bad for the sense of inner calm i am trying (seriously!) to cultivate.

i'm sure this guy would approve.



workout: 3 miles, average 8:25/mi. i can't remember the last time i did only 3 miles! but this short and fairly quick-paced little burst was pretty invigorating.

vegetable explosion: warning --> veg. overload!

this plate contained the following:

beets (local)
zucchini (local)
zephyr squash (local)
butternut squash (local)
onion (regional)

yeah! harvest season, indeed.

board prep: i actually studied the endocrine chapter of my review book last night! admittedly, there wasn't much new information there, but i appreciated the thorough review of the different types of rickets. fun fact of the day: X-linked hypophosphatemic rickets is one of the few X-linked dominant disease. ahh, so that explains why i saw a little girl with XLH the other day (most X-linked diseases are recessive and therefore seen primarily in males).


  1. Anonymous7:57 AM

    Haha your post cracked me up! I'm sending Dave this post since he's on call tonight and staying in the hospital. Your veggie explosion looks great! I still haven't had the chance to try beets.

  2. Yeah, those early night wake-ups were the *worst* when I was nursing. I would almost feel nauseous at times. Later in the night was always better.

    I hope you have a very uneventful week of call! Oh by the way, here the callers are fielded by a resident before allowing to disturb the on-call doctor. So if you have multiple teens as in the above scenario you can always move to Sweden for more undisturbed nights! ;)

  3. So do all diabetic kids have issues over night or are these kids who generally have poor control but everything is scarier at night?

  4. I also hardly ever run just 3 miles anymore - usually it's 3.1 in a race or it's more! But it's kind of freeing when you realize you don't have to run for an hour or whatever. I watched your HLS talk yesterday - it was fantastic. You are a great speaker :)

  5. Ive never heard of a zephyr squash. Ill have to see if they have some variation of that kind in Iowa!

  6. I just discovered your blog today and am so adding it to my google reader. I work as a lawyer in private practice and while my hours are not anything like yours, I need all the inspiration I can get for balance in my life :)

  7. Becky2:02 PM

    Ah I absolutely love ER! One of my favorite shows they had to end, like always. I'm a huge Grey's fan, but I liked ER because it was more about the medicine rather than who was sleeping with who haha.

    I find your blog so interesting because I am also going into the medical field, however I'm majoring in Nursing and I would love to work in the ER! I'm also a fellow Carolinian, but in the other Carolina - Columbia to be specific.

    Can't wait to keep reading :)

  8. Do you watch any other medical shows? One of my doctor clients likes Grey's (Gray's?) Anatomy because it really has nothing to do with medicine. I like House.

  9. atilla9:50 PM

    hey wait we called you cause one of the grandkids could not breathe and u helped!