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 . . .
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.
✔ "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.
✔ "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.
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).