Let me preface by saying that one, this is the first time I've "blogged"; two, these are my thoughts while on call and are not necessarily reflected by all others on ortho call or my colleagues.
Depending on the day, call either begins at 7am or 7pm on the weekends or 5pm on the weekdays. It lasts for about 12-13 hours. While on call, I am responsible for all phone calls for the entire practice. We have about 30 surgeons and about 18 physician assistants. We take all calls from all patients. The calls normally will be rather benign, but there is almost always a call in which a patient says "magic phrase" that triggers within me that pause for concern that says in the back of my mind, "Could I get sued over this?, or Could this person die as a result of this?" I hate those calls. In one call, I could simply brush this patient's concern off and lose my license or kill them. Or I could tell them to come to the ER for no reason and add to the already burdened ER's busy board and add to the patient's already large medical bills. Did I say I hated those calls? In one call, my actions could result in the death of a human being or the death of my career. No pressure.
My call consists of covering 3 emergency departments for all orthopaedic concerns. Does every call from these ER's involve bones or muscles or their being broken or torn. Not always, but usually. I can get calls regarding anything from broken hips or wrists to a compartment syndrome or gunshot wounds and mangled extremities like hands vs. table saws. (Table saws, and for that matter all power tools and farm implements, always win in that scenario). Most people would think that it would be difficult to see these things and while it does grab me in a visceral manner, it is not the most difficult part of what I do. The difficulty lies in trying to decide if I call in the supervising physician for this case or do I just "tuck it in" and let the day shift surgeon handle it. My delay in calling in the attending could literally result in loss of life or limb for the patient. Do I risk calling the attending in the middle of the night and waking him up for something that could wait? Do I risk not calling the attending for something that needs his attention rather quickly?
Most would say, "Are you or are you not a trained PA with medical training? Why can't you make these decisions without all the hubub?" Trust me, I have asked these same questions. Why can't I just make the decision? The answer actually is derived before call even starts that day.
Call Day: I wake up and think, if I shave today maybe my call will go well or maybe it will suck. Maybe if I wear my lucky socks, call will go really easy and I'll it'll be light tonight. Oh crap, I put my scrubs on before I put on my socks. Am I doomed? What if I wear my lucky shirt under my scrub top? That has to account for something. I sure hope someone doesn't say the "Q" word today. (Quiet). Well, whatever comes in, maybe it will be straightforward and easy to take care of. (Not likely!)
Call is as much mental as it is physical. I once heard that the only difference between me and a victim is my attitude in the midst of the trauma. Another one of my favorite books says that the first pulse to take in a code/trauma is my own. I am learning that, albeit slowly. The other thing I am learning is the limitations of my own knowledge. Even though I am a trained PA, I am not a board certified orthopaedic surgeon with 15-20 years of experience under my belt. I never will be. The difficult part for me is that I always seem to get the rare stuff that no one ever sees on call or stuff that people only see once in a career. For example, a 2yo spontaneous septic knee, a possible tumor in the hip in a 10yo girl, a fracture or dislocation that has a 1% occurrence rate in the population, or a dislocated shoulder that won't reduce, a bilateral jumped facet of the spine, or a dislocated spine, etc. I seem to get the people that should be characters on Grey's Anatomy or House. Or I get the patients with injuries or maladies that just rip out my heart. Young kids traumatized due to fault of their own. On the one hand, it is an awesome experience to see these things and treat them, but on the other hand, it is nerve wracking to be on my own taking care of these people. All I am going on is what textbooks say! (Textbook information is 5 years old at best.)
Call is being point man for an entire practice knowing that the entire practice is relying on me to make sure that none of their patients die that night. It is my job to make sure that nothing sinister befalls any of the patients that have entrusted their lives to us. I am the one and only person in charge of that. I am the one the phone calls come to. I am the one carrying the pager. I am the one the patient is turning to for help in their most dire time of need. All I can do is make sure I read and study for that next patient that call or comes in the ER. All I can do is continue to listen to my gut and know when I don't know enough to take care of something.
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