Night Float - Week One is Done!

     I was definitely a slacker on posting this past week, but I'll make up for it now!
     For those who don't know, Night Float is a system that many residencies have in order to decrease the amount of call residents have to take during the week.  Different family medicine programs do it differently: some have you do a week of night float once during a four week rotation of inpatient medicine, OB/GYN, and pediatrics...my particular program has one resident from each year (intern, second year and third year) work from 5PM to 6:30AM Monday through Thursday... same three residents each of those nights... and then the intern (that'd be me... intern = first year resident) also works from 5PM Friday to 6AM Saturday with two upper level residents who are on call that night.  This way, no other residents have to be on call during the week, and the night float residents don't have any duties during the day (other than one half-day of clinic) - in other words we don't go to things like morning report or noon conference.  This is so we can sleep during the day and not violate work-hour rules - as an intern, I'm not allowed to work more than 16 hours in a row, and I must have at least 10 hours off between shifts.
     The way my program structures it is that the third year resident on night float is in charge of inpatient adults, the second year resident is in charge of OB/GYN and inpatient pediatrics, and the intern does duties for both the adult inpatient and OB/GYN services.  In addition, the third year takes calls regarding patients in nursing homes covered by our residency, the first year takes calls regarding patients in the hospital as well as every other call that comes in from the answering service for our office and the offices of our preceptors as well as the prenatal center.  The second year takes the other half of those calls.
     Typically my nights have involved getting calls about patients labs, changes in their condition, needs for different orders, doing admissions, and going to any codes, deliveries and neonatal resuscitation there might be.  I also evaluate patients who come in to labor and delivery who think they're in labor/ their water has broken/ they're bleeding, etc. and I return calls from outpatients who have some medical question or another.
     There has definitely been a steep learning curve, and a lot of new responsibilities and systems to get used to, but I always have an upper year to consult with even the stupidest questions (to any upper years reading this: thanks for not outwardly judging me, even if you are rolling your eyes/ laughing on the inside).  But, at the same time, it's pretty awesome!  Not many people can say that they start their day off by delivering a baby.  And admitting patients to the hospital can sometimes involve doing a little detective work, which is always interesting.  And the patients themselves have some crazy stories, which can definitely be very entertaining!
     At this point I think I'm most comfortable doing admissions - I've been trying to step up my game in the transition from med student to resident and challenge myself to think critically and form assessments and make plans.  This is easier to do with admissions since I usually have the time to calmly sit and think (not to mention my senior resident guiding/ prompting me).  It's not so easy to do when nurses call from the floor at 3AM and say "Mrs. X's blood glucose is 250," or "Mr. Z's sodium is 125," or "So and so is in pain,"...or when a patient calls in and says "I'm having _____ (fill in the blank: contractions/bleeding/ discharge,etc) at _____ (fill in the blank again: 38/27/34) weeks...oh and I have this complicating factor, what should I do?" Thank God for upper level residents for those calls!  That's when I go into sponge mode and try to soak up as much learning as I can since I don't have enough experience at this point in time to always know what to tell people!
     I think one of my weaker areas is OB.  My OB/GYN rotation was almost two years ago, and since we were guinea pigs at the site I did my third year rotations we didn't always get called for deliveries, and patients weren't used to having medical students around, so it wasn't always easy to get to do cervical checks, or to see tons of vaginal deliveries, etc.  So now that I'm here and determining how far dilated/ effaced/ what station a woman is at during labor is kind of a new thing for me, and let me tell those of you who have never had the occasion to do one: cervical checks are hard!!  I'm sure some day - maybe 6 months from now, maybe 3 years from now - I will look back and read this again and struggle to remember the day when I thought of cervical checks as anything other than second nature, but for the time being I'm still in the everything-feels-the-same-in-here phase.... it's all warm and wet, and sometimes if I'm lucky I can actually find the cervix and take a stab (no pun intended!) at how dilated they are, etc.  It's going to take practice, practice, and more practice.  Meanwhile I'm sure my patients these first few months will be thinking "thank the good Lord and all that's holy for epidurals!"
     My OB-related responsibilities while I'm on night float are always my most challenging for several reasons: I lack experience in OB, and I'm always keeping in mind that deliveries can be dangerous, and I have not just one patient, but two.  There are a lot of factors to consider when working with pregnant patients both in labor and not: blood type, GBS status, how far along they are in their pregnancy....and so much more!
   
     Overall this first week of night float was a success (at least I think so!  hopefully the second and third years I worked with would agree and aren't out there thinking "wtf, who let this girl graduate from medical school!?").  I keep forgetting what day it is and that when I get home from a shift just because I've been awake and working and it's light out doesn't mean the rest of the world has: mail hasn't come, garbage men haven't been by, e-mails won't have been answered, phone calls won't have been returned.  And vice versa... while I'm sleeping the day away, a whole lot of stuff is going on!
     In medical school I used to lie in bed in the morning thinking "I'm exhausted and I don't want to go to work today," pretty much every day of most rotations (don't judge me!)... so far at least that is different now.  Yes, I still wake up thinking "It's time to get up already?!  But I just fell asleep!"  Only now I think "work is going to be really cool tonight and I'm going to learn so much."  I think that's partly to do with the fact that I'm more invested in my patients and partly because I love the people I'm working with and the program I'm at.
     Here's to a relaxing weekend off and a great second week of night float!