As a first year Ob/Gyn resident we only spend 3 blocks (4 weeks) “on service” meaning, doing Ob/Gyn rotations. We spend the other 10 blocks on “off service” rotations (other specialties). For my residency program, we have 2 blocks of General Surgery, ICU, and Internal Medicine; 1 block of Emerg, Anesthesia, and Women’s Health Psych/Sexual Medicine.
I recently completed my two blocks of ICU. Click here for helpful resources.
This is what a typical 24 hour on call shift might look like. At the hospital I worked at, if you were the on call resident, you would be carrying the code/CCRT pager.
What is a code pager? Codes mean “code blue” – these are usually called if someone had a cardiac arrest or someone is found unconscious. Sometimes, a code might be called if a nurse/healthcare provider feels like they need more hands for a critically ill patient.
What is CCRT? CCRT stands for Critical Care Response Team. Essentially, this team includes a nurse, a respiratory therapist, and an MD. We are called to respond to “pre codes”. These are situations where a patient may be heading towards critical illness and may require transfer to the ICU. If the patient is NOT transferred to the ICU, the CCRT nurse/MD will check up on the patient afterwards to ensure that they are still stable. If their status changes, then we transfer them to the ICU.
Here is a day in the life of a Junior Resident. It’s hard to capture all of the pages you answer in a day, so I will just add a few to give you a small sense of what it is like.
6am – Wake up.
6:40am – Leave the house. I was doing ICU in a city that was 1 hour drive away, so it meant long days.
7:40am – Arrive at hospital. Change into scrubs. Grab a patient list for the day
8:00-9:00am – Handover of overnight issues, overnight admissions, and generally some kind of morning teaching
9:00-11:30am – Team rounds. We have one attending staff for the week and 4-5 residents per block. The residents are a mix of specialities, including Ob/Gyn, Family Medicine, and Internal Medicine. We round with an interdisciplinary team including nurses, dieticians, physiotherapy, and pharmacy, and respiratory therapy.
11:30-4:30pm Assign patients that we will go follow up on in more detail. When we have a patient assigned to us, we do a full physical exam, review labs in detail, order tests, and communicate results to patients/families.
2:00pm – Code blue. It’s one of our own patients in the unit. We start CPR and give medications according to the ACLS algorithm. They have a pulse after 4 minutes of CPR.
Codes can be called at anytime, in any part of the hospital. This time, it was in the unit where we have highly trained staff. You have to be ready to enter any situation and drop what you’re doing at a moments notice. In those cases, it’s important to communicate to your team if you have a critical patient in the ICU that needs looking after as you go to the code.
5:00pm – Nighttime handover. We had a second staff attending MD come in to cover nights, so we give handover to them so they know what is happening in the unit.
7:00-9:00pm – First consult from Emerg. I’m called to see a patient who is likely septic. They have persistently low blood pressure and they’re requiring more and more oxygen. Additionally, their kidneys aren’t doing well and they may need dialysis. I will consult nephrology later if it looks like they will need dialysis. In the meantime, I admit them to the ICU. I use ultrasound to put in a central line (an IV through the Internal Jugular vein) so that we can give them pressors (a medication to increase their blood pressure).
9:00-9:30pm – “Tuck in rounds”. I go through the unit and talk to each bedside nurse to see if there any night time issues that need addressing before I try to catch some sleep. I put in orders for pain meds, fluids, and blood transfusions, then make my way to my call room.
11:00-12:00am – CCRT pager goes off. A patient is looking drowsy and is not waking up as well as they were before. I look over their medication list and see that they had some opioid earlier in the day. I order narcan and that doesn’t get them back to their baseline. Their sugars are ok and they don’t appear to have had a seizure. They’re protecting their airway so I don’t think they need to come to the ICU. I order a CT head to be thorough and it comes back negative. We will follow this patient to make sure they’re ok.
12:00am – Back to the call room to sleep
1:15am – I get paged by one of the bedside nurses that one of our patients has maxed out one of their pressors, but their blood pressure is still low. I give them some fluid and give an order for a second pressor.
2:30-3:30am – Next consult from Emerg. This time it is a polysubstance overdose. The Emerg doctor has already intubated the patient and called poison control. I see and admit the patient to the ICU since they are being ventilated.
3:30-3:45am – Since I’m up, I do another sweep of the unit to see if nurses are missing any orders. I check in on the patient who had maxed out their pressors. They are stable, but might need a third pressor added. After I finish my sweep, I head to sleep.
5:00- 5:15am – I am paged. A patient is fighting their ventilator. I order some medication to help sedate the patient. It seems to work well so I go back to sleep.
7:15am – wake up. I brush my teeth, wash my face, and go grab a coffee. Then I sweep through the unit again to see if any other issues have come up. Usually the morning bloodwork is back and I can put in some orders before heading to handover.
8:00am – I handover the overnight issues. We have a teaching session.
9:00am – Leave the hospital
10:00am – Arrive home and somersault into my bed… Aah that feels good!
Photo via Allie Smith Via Unsplash