On-Call Survival

I know this post won't apply to most of you, but given the proximity of July 1st, I felt this was an appropriate time to discuss this.

What is July 1st, you ask? July 1st is the first day of the academic year in Medicine. It's the day that new interns start their training as freshly minted doctors, residents each go up a notch in their training, and 3rd year medical students start their clinicals. For most medical students, and even some interns, this is the first time that they'll be on-call in the hospital overnight, which to many presents quite the challenge. On July 1st, I'll start my PGY5 year. I can tell you that after being Q4 my entire M3 year (before the 80 hour work week), Q4 for 4 months as a M4 (2 regular sub-internships and 2 elective ICU rotations), then Q4 most of my residency until critical care fellowship (where I'm Q4 for 3 months and then take a TON of home call), I have this on-call thing down to a science!

I think there are 2 different styles to being on-call, the super minimalistic and the overpacked. Not many people actually fall in between. I'm definitely the overpacker!

The super minimalistic on-call person usually brings a toothbrush, toothpaste, and sometimes they'll bring deodorant. Not always. This usually is a male, and more often a surgeon, but plenty of the guys in my peds residency class fit into this category.

I have a huge call bag (pictured here is what I actually carry, at the top of the post is what I wish I carried!) If you fall into the overpacked category with me, here's what I carry with me in my bag:

Longchamp Leather Duffle Bag
Nike Duffle Bag





Beauty

Looking like a normal person post-call is truthfully next to impossible. Unless you are a huge white cloud and sleep for 8 hours without interruption due to cross-cover issues or admissions, chances are you will be tired, dehydrated and have huge bags under your eyes. As well, if you've been busy the likelihood that you've actually gotten to a bathroom to wash your face and apply night cream is pretty low!

While in the hospital for long shifts, I try to drink a LOT of water. I will make a big purchase in the cafeteria of about 3 bottles of water, and I try to drink all of them. This can be very difficult with JACHO banning drinks in most areas of the hospital, however, drinking water really can be a savior on-call. I swear I can almost feel the hospital arid environment pulling the moisture out of my body!

I keep a basic makeup kit in my call bag. These products are chosen for ease of use, if I manage to make it to the restroom to apply anything, I'm sure to be done in mere minutes!


Revlon Colorstay Concealer I love this Revlon Concealer for how easy it is to apply. Even if I don't have time to get to the restroom to do a quick application of my makeup, I can use a quick swipe of this under my eyes to look more awake. It's so easy to use and blend that you don't even need a mirror! Plus, they have a pale shade that actually matches me, always a bonus!


Revlon Pressed Powder A quick swipe of any pressed powder on your t-zone can easily disguise how long you've been up without even washing your face! It can be hard to find one that doesn't look chalky with your complexion. I personally do well with the fair shades from Cover Girl and Revlon's lines-- you might be different. If you buy a acne fighting formula, this might be even better!


Cover Girl Lash Exact in Brown-Black For me a major thing in appearing awake post-call is to have fresh mascara. I keep an extra eyelash curler and mascara in my bag. I love this mascara because it is so easy to apply! The special brush makes clumping nearly impossible, and this formula is both smudge and flake free. While I don't get the big, thick almost false eyelash look that I get with my holy grail mascara (L'Oreal Shocking), I do get a great curl that lasts, and my lashes definitely look longer. I use black-brown rather than my normal black, because I tend to be even paler post-call and black mascara is too harsh. Be sure to remember to change out your mascara tube every couple of months. Even though this mascara isn't used up in that time period, bacteria has had more than enough time to grow!


Cover Girl Eyeshadow Trio I don't usually have the time for a full eyeshadow application post-call. However, a soft wash of the lightest color in this eyeshadow trio and maybe a little bit of the darkest color used as a liner makes me look much more finished. I apply this quickly and don't spend too much time trying to get a lot of pigment on the lid. I recommend buying the most basic light brown shadow compact you can find- post-call is not the time to play around with purple and teal! I also have a very small brush collection (really, not a fancy one, I have the $3 travel set that was on sale at Target one year in the travel sample area). It's fine to use the little applicator that comes in each of these compacts as well.


L'Oreal Blush If you have the time, a light sweep of pink blush will make you less like a cast member of "Night of the Living Dead." I recommend going very light and natural with your call-bag blush. I made the mistake as a medical student of bringing with me a brighter blush, lighter than my norm, but still bright. No matter how little I applied with my post-call pallor, it just didn't look quite right. It was quickly replaced!


Carmex Again, moisture is key while in the hospital, and your lips just might be the most overlooked part of your body. I have Carmex (or it's sister product, Lip Medix) in my call bag for those nights that I do make it to the call room. I also use Kiehl's Lip Balm at the hospital very often. Your lips will thank you if you remember to take care of them!





Miscellaneous Beauty Items to Remember:
1. Nail Items: I have a nail file and nail clippers in my call bag. If I get a small break in a nail I am someone who can NOT let it be, and it will drive me crazy. I'll end up bitting the nail off rather than have a broken nail. I also have an extra bottle of nail polish top coat. If I get a little chip in a mani, a quick coat of Seche Vite (which dries in 10 minutes at the most) over that area smoothes things down, and I'm much less likely to have more chipping. If the chip is really bad, I carry a Cutex Nail Polish Remover Pad with me to take off my mani. I realize this is all very obsessive of me, but honestly it's what I have with me!

2. Moisturizer: I can not stress enough that moisture is key in feeling comfortable on-call and post-call! With multiple hand washings, your hands will dry out. Especially in winter, when you are more likely to be around patients with infectious issues such as Influenza, RSV or Rotavirus, I recommend washing often and using a hand lotion afterwards. I have tried lots of different hand lotions. Curel and Eucerin are both great, but tend to be way too greasy for me. Neutrogena's Norweigen Formula was a favorite of mine for years, however it doesn't seem to last through many washings with Chlorhexadine soap (I use it, and I hope you will too!). A few years ago I discovered Kiehl's Ultimate Strength Hand Salve, and I've been recommending it to everyone at the hospital ever since!







Hygiene

Tooth Pack It's important to remember to have a quick and easily packed substitute for each step of your daily routine. This little pack should be obvious. Don't forget the floss if you need it, and a little Scope or Listerine can go a long way that post-call morning!


Pond's Clean Sweep While I do carry in my call bag a small travel size bottle of Bliss's Fabulous Foaming Face Wash (from the Bliss Travel Set), I don't always have the time to start over. As well, I don't wash all of my makeup off when going to lay down during the call night- chances are you'll need to hop up and run off to somewhere. I love these face cloths. I have tried quite a few kinds from Olay, Neutrogena, and other companies. None have removed my makeup quite like these. When laying down for a nap during call I will quickly run a cloth over my t-zone and any shiny areas, remove my concealer (and usually apply again) and that's it! No rinsing needed. I also have a stash of these at home for use when I'm too tired to go through my entire night routine- they remove almost any eye makeup, all foundation and blush, you name it!



Miscellaneous Hygiene Items to Remember:
1. Deodorant
2. Contact Lens Supplies/Extra Glasses
3. Hair items such as a brush and ponytail holder.



Meds

Amazingly enough, even though you will be spending roughly 30 hours in a hospital, if you need a medication the chances of you being able to get that med (unless the outpatient pharmacy sells it, and they happen to be open) is slim to none. So, I like to be prepared!

Tums Obviously these are for the hospital cafeteria food, the bad delivery food and everything you will be eating out of the vending machines. If these become a habit, strongly consider a PPI or H2 blocker instead. I have several small rolls of these in my call-bag, and after Tylenol/Motrin, it's probably the thing that I give out the most.

Imodium I know, Imodium doesn't seem like an obvious thing to carry with you. And usually this is not something that I have in my call bag, it's a seasonal item. I can tell you that every pediatrics internship must be plaqued by a bout with Rotavirus, and it nearly always hits while on-call! Not a great solution in the long run (IV fluids and being sent home may be better), but if you have just a small issue, Imodium may make getting through call much easier and more pleasant for everyone involved.


Sudafed During the cold and flu season, it's pretty common to feel congested. But, feeling that way in the arid and cold environment of a hospital can make the whole thing feel just so much worse! I keep just a few of these with me. I DO NOT recommend taking these to stay awake. I know some people do it, please don't become one of them. It doesn't even really work anyways, so it isn't worth it, that's what coffee is for!


Tylenol and Advil are most likely the medications you'll need most while on-call. You'll be amazed at how few people have some with them, so I have a bigger stash probably than I need. I don't give it out to visitors, but I'll often give some to attendings, residents, nurses, radiology techs, you name it! I like to have both options, since I use both medications, but this is obviously really up to you.



Don't forget prescription meds!
A lot of us have our own medical issues, and remembering to take your own medications, while hard during a call night, can make your month on service a much healthier one. I personally have my albuterol inhaler with me (I sometimes need it if I run to a code), and I have an extra Advair diskus in my call bag.





Clothing

Every hospital, training program and region of the hospital is different, and you may need to scope this out before your first call. When I was in medical school, call was fairly formal. You were in business clothes during the day, at about 7 pm we were allowed to change into scrubs, but you were expected to be in different clothes by 7 am the next morning. During my peds residency in California, we wore scrubs in to work the day of call and wore them home the next day. Same for my fellowship. Currently the only clothes I keep in my bag are an extra set of scrubs (in case something gross gets on me), a sweatshirt for when I'm cold, and a change of socks and underwear for in the morning.






Extras

Shout Wipes I love to keep a few of these Shout Wipes in my white coat pocket and the rest of the box in my call bag. These things rock! I have tried the Tide To Go Pen and similar products, however they don't work quite as well for typical hospital stains. I've used the Shout Wipes with great success on blood, vomit, coffee, ink and betadine. I have no residual stains! Just use them early after the stain and blot, don't rub! Wash the clothing as soon as you can.


Stadium BlanketThe biggest thing in my call bag is my blanket. I know a blanket isn't standard in most call bags (I did say that I'm an over-packer!), but I know residents who bring blankets and pillows as well, so I'm not alone. I personally bring a blanket because I am always cold in the call room, blankets are often in short supply in the hospital, and if I'm cold then I won't be able to sleep. End of story. So, I have my own blanket. I have a stadium blanket from high school, it is wool and has a theme very similar to this one, it's a Michigan blanket (where I went to school for college and medical school). The fact that it's covered in the Block M and football helmets keeps anyone else from claiming it belongs to them, and since it is wool it's warm but lightweight and easily packed into my call bag.




Tips for surviving training

There are a couple of things that you should know before you start this next level of training. I'm sure you've heard these tips before, but keeping them in mind may help that internship go a little bit easier!

1. Be nice to the nurses. Actually, not just nice, be NICE!! The nurses will literally be the people who decide how well your call night goes. If you treat them with respect, ask for their opinions and take their concerns seriously, this will go a long way. Let them call you by your first name- they are NOT your employee, they are your collegues. I have always had good relationships with the nurses, and my fellow residents and fellows wonder why I get treated so differently. This is why, I treated them well from the beginning and it paid off.

2. Act professionally. Acting professionally should be obvious, especially when patients and their families are present. Speak professionally, don't gossip, follow up on your patients- you should be the first to know about that INR of 3.4, not your senior resident or attending. Read about your patients and take ownership. A huge complaint since the institution of the 80 hour work week is that residents view medicine as their job and not their career. Make this your career and try to do this as well as you can. Everyone around you will appreciate it!

3. Dress professionally. This also should be obvious, but somehow seems to be falling more and more by the wayside. Jeans, shorts and capri/crop pants are never appropriate at the hospital. I don't care what your attending wears, I guarantee that quite a few of the patients don't like it. Never wear open toed shoes, not only do patients not like it, it's against federal regulations (JACHO and their $10,000 fine), and it's also dangerous. A lot of procedures may involve unanticipated blood splatter, you might drop a sharp, someone vomits on you, etc. All of that is much easier to deal with in closed toe shoes. Look at what those above you are wearing to guide you- if your attending is in a suit and tie, dress accordingly. Being appropriately attired is not important only in residency, but to an even greater extent in medical school, when your grades are so important. Wearing a belly baring shirt to work will not gain you a better evaluation from your senior resident, it will cause others to gossip behind your back.

4. Bring snacks with you, you never know when you won't be able to eat a meal. I have an extra bag of trail mix with me in my coat pocket, often this has become my dinner.


I hope this has been helpful, let me know if you have any tips to add! Good luck in July!