Last Call

I recently had a bittersweet last call as a medical student. I can’t say it was one to quit on, but it certainly made me glad to have that chapter of my life finished. On the last service I rotated on, we took call every third night, meaning that we would stay overnight until 6AM, then round as usual on our regular service, and either stay to assist and observe operations or clinic the following day, or go home if we weren’t feeling up to it (the residents never stayed post-call). The end result is often a 30-36 hour “shift” with 1-3 hours of sleep squeezed in between there somewhere. The longest I stayed was 38 hours, which is fine until you remember that I left at 7PM and had to come back at 5 AM the following day.

Call as a medical student feels particularly self-flagellating – you aren’t working, so there isn’t ever anything you actually need to do. No one is actually counting on you being there. You’re following your resident around hoping to be included, hoping that they don’t ditch you or disappear since you often don’t have access to the call rooms or resident lounges. Hopefully you’ve managed to grab their cell phone number – they are definitely not answering your pages – and hopefully you are familiar with the hospital by now.

You can rarely be helpful, and this is a time when residents are almost always looking to be as efficient as possible so that they can snag a little sleep. You spend a lot of time watching someone else perform procedures, put in orders, or see a patient. And believe you me, shadowing someone else working at 2 AM when you’ve been up since 4:45AM the previous day is a particularly difficult experience.

It’s also, in many ways, a uniquely educational experience. You get a taste of what it’s like to be a resident, but I wouldn’t ever equate the frustration and annoying shadowing of medical student call to the pressure and stress of call as a resident. You get unique access to your residents and you see what they are really like – and you can get to know them and bond with them. Occasionally, if your lucky stars line up, you might get to play a bigger role in an operative case or bedside procedure that you might not ordinarily get to perform during the daytime. You might get to be the first person sent to see a consult and have the experience of trying to organize your thoughts and write a coherent note under time pressure and fatigue. You get to know the other staff and your patients much better than if you clocked out at 5 PM.

Of course, there are some technicalities worth mentioning. Most medical schools mandate that their medical students do not exceed PGY-1 work hour restrictions (80 hours a week, 1 day free in 7, 16 hour shifts maximum with 10 hours free from duty). This is of course incompatible with call. However, it’s not clear on whether the rules apply to those who are “voluntarily” taking call … whatever that means …

I’m glad that this phase of my life is over, and I can’t wait to be on to the next thing, which for me is a series of interviews and classroom / didactic rotations mixed with lighter clinical rotations (with no call). I will have many residency overnight calls during the coming years, and I do look forward to those. Onwards …

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