The Unpredictability of Weekend Call

It never fails to amaze me, how random call can be.

I’ve had a wonderfully long stretch without taking call. I mean, we carry our pagers Monday through Friday, and answer any after-hours pages on our own patients during the week, every week. When I say I am on call, I mean it’s my turn to take all the calls for the whole practice for the weekend. We take turns with the weekends, and it’s been several months since my last turn.

Nowadays, call is fairly light, as a rule. With the advent of the online portal a few years ago, where patients can essentially email the practice for a wide variety of issues, including emailing their own doctor with as lengthy a tome as they like, at, for example, 2 a.m., those after-hours calls dropped off sharply. This coincided with stricter prescribing laws and protocols around controlled substances; once patients figured out that they would not legally be able to get any Percocet/ Oxycodone/ Valium etc via a phone call, those annoying pages disappeared. Then, with our practice decision last summer to admit our patients to the Hospitalist service, instead of managing our inpatients ourselves, the calls dropped off even more- No more nighttime calls from the emergency room or the residents. And, no mandatory rounding, either.

Hence, the weeknights are blissfully quiet. If I am on call for the weekend, it means that I’m covering the practice from Friday afternoon at 5 pm through Monday morning at 8 am, and there’s usually a few more calls, as I’m covering fourteen other physicians.

So, even when we are covering our entire practice, call is really not that bad. But, occasionally, a page will come that demands immediate and total attention, for an extended period of time. By Murphy’s Law, this is always during family dinnertime, bathtime, or kid’s bedtime.

Last night, Friday night, I had a number of pages regarding critical lab values. It’s odd to get one, never mind a handful of these. And they all came within a short time span, basically just as Hubby and I stumbled in the door with two muddy, sandy, overtired children and all their bags from school and our work bags and a bunch of shopping bags… We had had a lovely dinner at Nana’s, and got home a tad late.

Of course, critical lab values are paged to us for a reason. They’re, like, critical. But the lab tech who is calling me knows nothing about the patients or the case. So, when I got the pages about the really really low potassium; the really really high Vancomycin level; and the really really high blood sugar, I needed to get to my laptop, log into work (through a special connection, I can access the electronic medical record from home), read some charts, and make some phone calls, STAT.

Now, Hubby owed me. He had work events several nights this week, and I managed the bulk of dinnertime/ bathtime/ bedtime (with help from Nana, as per usual, who had usually fed the kids really well before they came home to me). So when the pager went off last night, he gave the “I got it” sign and shepherded the kids upstairs to the bath.

As I furiously scrolled through charts and flipped through labs and read reports and tried to figure out the best plans of action for each critical result, I could hear splashing and squealing and scolding and… the clatter of toys being thrown across the bathroom, several thuds, and then the pounding of feet chasing down naked runaways and, of course, the sounds of a huge mega-mess being made upstairs.

But, what do you do? I felt badly, and kind of stressed, wondering how much time I had before Hubby blew a gasket. I read through all the charts, one by one, and went into action, case by case.

I called the lady with the low potassium and came up with a plan based very much on the plan that was used by her own doctor last time this happened and then documented that all in the computer. I paged infectious disease on-call and discussed the Vancomycin level with them and then called the lady and communicated the plan, and then made a note to get in touch with the home health care agency and recheck the labs and then typed that all up. Then I called the other lady and had her go to the emergency room, and I called the ER and told them she was coming, and then typed that all up too.

Meantime, somewhere towards the end of all of that, Babygirl came downstairs on her own. Her hair was still all wet and tussled, but she was clean and pajama’d. She reached her little arms up to me (I stand when I type, at home) and said, quietly, her voice a bit rough and hoarse from the cold she’s had:

“Mommy, pick me up.”

I was finishing up my conversation with I.D. and I glanced down at her.

“Mommy, Please pick me up.” hands still reaching up.

I was still chatting with I.D.

“Mommy, PICK ME UP ! PICK ME UP!” in that tone that signals full-on meltdown will happen if this is not done.

I.D. chuckled, and I picked her up. As soon as I was able to put down my phone, I logged into YouTube and pulled up her favorite, “Old McDonald Had a Farm” children’s music videos. Hubby came down with a scrubbed and pajama’d Babyboy to prepare their warm milkie sippy cups and try to herd her back upstairs, but this time I gave HIM the “I got it” sign, and I typed my notes as she watched version after version after totally insanely interminable version of freaking Old McDonald. But, I typed, and got it all done, and then rocked Babygirl to sleep, singing her requested song many more times: Old McDonald.

There were no more pages, all night long. Today, Saturday, there have been a mere handful of benign calls: a UTI, conjunctivitis, a sinus infection.

We’ll see what tomorrow Sunday brings. A beautiful early summer Sunday… Should be light. But, you never know.