Throwback

So I'm postcall.

I know, I know, I said I was never going to have to take call again, there may have been a happy dance involved, etc. But, to clarify, I believe what I actually said was more that after that, any time I was doing "call" it was going to be voluntary and heavily compensated. And this was.

I think we killed Veronica on Friday. She and I left Friday night about the same time, she'd had one beer, she was looking a little peaked, but well, she's an intern, they always look a little peaked. We left because she was on call yesterday and I was just freakin' tired and had shit to do over the weekend. So I came home, blogged, stretched out, fell asleep a little after 1. Woke up at 7:15, of course (after waking up at 5), and was sort of dozing, mostly refusing to get out of bed, and my phone rings. And it's one of our chiefs, and she's like, "The intern is sick and can't take call. I'll give you three comp days if you do it."

Once I actually woke up, I was like, hell yeah. I'm all over it.

So I made a mad dash for the shower, found my scrubs, ran out the door, and despite my commute and the proximity of her calling me to the start of the shift, I made it by the end of checkout rounds. I was on with Scott, and we had a rockstar medical student (also named Kate). And two new ED evals waiting for us by the time I got there. So Scott went off to Second Year Consult Land, and the Kates headed down to the ER. Go team. Break!

It was a constant stream. We were essentially bedless, so there was a lot of referral action going on. It was a crazy shift. I didn't see my office after I dropped my stuff off in the morning, much less my bed. And for that level of chaos with two upper levels on, I can't even imagine how awful it would've been for a sick Veronica.

Crazy.

But interesting, and amusing in a lot of ways. We had some really good cases. Scott and I work well together, and Kate did a great job. We functioned as a remarkably good team, actually. And we had a couple of short lulls. One was like early evening, when Kate was still there, and we had a very good discussion of object relations and projective identification and a whole bunch of related nonsense that Scott and I are both pretty into, and she seemed to really enjoy. The second was sometime after midnight, when Scott and I finally got around to ordering dinner (one thing I did not manage to do during my AM Tasmanian devil impersonation was grab any sort of provisions for the day, because, well, yesterday was my day to go grocery shopping...). Of course, we hadn't had lunch until 3:30pm, so, midnight seemed pretty reasonable to us. Tarheel Takeout had already stopped delivering by the time things quieted down enough for us to think about food again, but we discovered this pita place nearby that delivered, and was pretty tasty. Good falafel. He and I also had a chance to decompress a little about some issues in the residency that we generally agree on, but on which we often have different outlooks.

One thing I found especially amusing yesterday was how shocked the medical student was that we all talked so openly about being in therapy. We both kind of shrugged and were like, well, how are you supposed to see things in other people's patterns if you don't know anything about yourself? I gave her my standard line of, I really think the key to being a good therapist is having a good therapist.

It also was remarkably helpful that I was on last night in that one of my patients had to come back in to the hospital, and I think it made it a lot safer and easier for her that I was there. She and I have a good therapeutic alliance, and wow, she really looked like hell when she came back in. We talked for a bit, she cried a lot, and by the time I'd gone back in to have her sign the paperwork, some outside influences had made things even worse. I hugged her before I left. We try to use physical contact very sparingly and with intention in this business, but sometimes, a simple pat on the shoulder or a careful and genuine hug can be the single most therapeutic intervention.

But while it was really good for her that I was there, it was really pretty upsetting to me that she came back, for reasons of my own neurosis. I, obviously, was so glad she was able to come back and to be safe and ask for help, but the transference in our interaction being what it is, and my own internal critic being as it is, and the fact that I was sleep deprived going in to the shift and had now been awake for like 21 hours made it really hard for me to see her looking as dysphoric as she was so soon after I'd last seen her. People who aren't in our profession really don't understand the depth of the internal tumult that goes on when you're surrounded by the sort of external chaos that we are.

The end result of that last night, unfortunately, was me yelling at a Neurology consultant who was trying to dump work on me in a pretty condescending manner. I actually hung up on him. Scott's commentary on that was somewhat pointed (see above re:sleep deprivation). He was like, "He's a good guy. I'm not saying he wasn't an ass to you right now." I ranted for a moment and then turned to him and said, "You can tell me if I'm being unreasonable." He thinks about this for a second and says, "Emotional, maybe. Logically, that was a reasonable request, but the emotions are out of proportion." I couldn't argue with that. Later, after the neurologist had actually done what I'd asked him, and I'd done what he'd wanted me to do, and I finally did agree with him that the neuro exam was pretty unrevealing in that patient, I paged him and apologized.

Interestingly, the apology was what Scott got kind of snarky about. I was driving home today and thinking that whole story arc of last night was a whole kitchen full of pots and kettles....

On the plus side, I did get a couple hours' worth of postcall nap in this afternoon. Oh, there is no greater bliss than a good postcall nap...

So now I'm actually going to go to bed, because I do have a 7am therapy patient tomorrow, and it's been a long damn weekend. But, really? I love my job.