First on-call shift during internship - what to know before the night

What makes this night different from all other nights? The answer is: your first on-call shift, which usually happens during internship, and it is an especially stressful moment. So how do you prepare, what should you bring, what does the shift look like - we'll talk about everything you need to know, and everything I wish someone had told me before my first night in the hospital.

I'm Dr. Elisheva, and in Medicine Unfiltered I tell you about the whole path in medicine, from medical school to residency, and about real life as a doctor. Let's get started.

## Basic logistics

Let's start with the logistics. An on-call shift lasts up to 26 hours, and by law you have to clock out after that time. On a call day, you come to work as usual, like any other day, and continue until the next day. In addition to the day you go home after the shift, there are three cases in which you get another day off during the week - called "202 time off": - a Thursday and Saturday call shift in the same week - a Friday call shift - working Friday morning plus Saturday in the same week The logic is that there must be at least one rest day during the week.

## What to bring to your call

Organize a call bag for yourself: basic toiletries with a toothbrush and anything else you need, water, a charger, spare socks, glasses if you wear contacts, including prescription sunglasses for driving home the next day (yes, I thought of everything), a sweatshirt, a water bottle, food, a few snacks, and maybe coffee capsules or tea that you like. Also a book - yes, yes, it sounds bizarre, but if the shift is quiet (knock on wood), you'll be happy to have something calming.

And of course, don't forget your most important medical tool. And no, I do not mean a stethoscope. I mean a pen. A stethoscope is no big deal; you can find one anywhere. Try finding a pen in the middle of the night in a hospital.

What do you not bring with you? Your imposter syndrome. You successfully finished medical school, and therefore you have the training required to be exactly where you are right now. Take a second to think about that sentence.

## How to arrive prepared

First of all, as interns, know who the doctor directly backing you up is, who the attending on call is, and who the charge nurse is during the shift. It is also worth knowing the phone numbers: for a code, for the ER doctor on call, or for any doctor from another department who may be relevant during the shift. I highly recommend introducing yourself to the nursing team when you arrive. It is worth getting on their good side because they know the department and how things work better than you do, and they can help a lot. Also, of course, introduce yourself to the resident. Do not be embarrassed to tell them this is your first call shift (help). Also ask them: let's align expectations - when do you want me to call you, what things are important for you that I consult about, and how do we divide the work between us? They will appreciate it.

Bring access to ACLS with you - an app on your phone, or a little pocket booklet for boomers.

Regarding equipment and places: make sure you are oriented to where all the emergency equipment is - the defibrillator, the crash cart, and also the coffee machine. Also find out at the beginning where the call room is where you can sleep. You really, really do not want to start looking for it at 3 AM and then discover it is locked and nobody in the building has a key. True story. Personally, at the beginning of the shift I already make the bed with sheets, so later when you finally have an hour to sleep you can simply collapse onto the bed.

At the start of the shift, make sure to be present at the handover of the department or ER doctors. It is very important to hear who the problematic unstable patients are, who needs attention, what events are expected during the shift, and what tasks were left for the shift to complete. Take a page and write down which patients you need to pay attention to and what to watch for.

## What happens during the shift

As interns, you are usually not alone and there is always a resident as backup, except in certain situations where there is an adjacent department with a resident who is your backup. And sometimes interns are left alone in a very quiet department. For example, when I was an intern at Wolfson, we did calls in hematology; nothing happened there, and the most dramatic thing that happened at night was giving paracetamol.

Do not be afraid to ask. The fact that you are on call does not mean you know everything - if there is doubt, there is no doubt. Meaning, if you are debating whether to consult, do it. Remember, no one will ever complain that you asked, but they will definitely complain if you did not ask when you should have. Calling for help is not weakness - it is good medicine.

When you call to consult, first be clear on three things: 1. a brief presentation of the patient, who they are and their background, 2. what their acute problem is, and 3. what exactly you need from the person you called. This will help you sound organized and professional, and people will take you more seriously.

Remember to write down and document every important thing that happened overnight, especially when it is the kind of shift where you need to present something in the morning. That way everything will be ready and you will not be stressed.

And maybe it sounds bizarre that I need to say this, but during the shift: eat, drink water, and pee. You stop what you are doing unless you are in a code, and take care of yourself.

What do you not do on call, or rather, what do you not say: "The shift is quiet." "Wow, the ER is really empty today." "What, no admissions?"

## How you sleep on call

According to the law, you are supposed to get two hours of what is called "rest" during the shift. As you can tell, they were afraid to call it sleep; you are only allowed to "rest" or nap. In practice, your sleep time will depend very much on the workload and on whether you are splitting the night with another intern or resident. For example, often in the ER there are two of you and you split the night from 12 to 4 and 4 to 8, and only if there is a crazy workload do they wake the second intern. If you are on the ward with a resident and you are already experienced and they can trust you, the resident may split the night with you.

By the way, if they let you choose, and you have plans the next day and do not want to be a zombie, choose to sleep between 4 and 8.

You may notice that by the time you get to sleep, even if you are exhausted, it is hard to fall asleep. That makes sense: you have been walking around under bright lights, full of adrenaline, and it is hard to switch into sleep mode. Bring a book or listen to calming music.

I also recommend using every moment you have to rest, even if it is short. It is true that when they wake you after an hour, you will feel like it is the resurrection of the dead, but after a little time, that sleep will save you and let you keep functioning later in the night.

When we are woken up in the middle of the night, we feel startled, disoriented, with a heart rate of 200. Unless they called you to a code, you can always take a few minutes to get yourself oriented. Drink a glass of water and give your eyes a second to adjust to the light.

## What the day after looks like

In the morning after, you may feel a sort of high that comes with extreme sleep deprivation. It will pass quickly, and you may have a little bit of Stockholm syndrome and paradoxically find it hard to leave the hospital. Go home.

If you barely slept at all and you have a long drive home, please, please check if there is an available room where you can stay and sleep for a few more hours so you can live and make it to your next call shift.

Unless it was a special night where you managed to sleep more than four hours, I do recommend sleeping for an hour or two as early as possible during the day so you do not ruin the following night as well.

So this is the first call shift, and no matter what happens during it, it will end in the morning. Your goal is not to prove that you know everything. It is to get through the night safely, recognize when you need help, and learn for next time. And remember: we have all been there.

I hope this video helped you. I invite you to watch my video about what really happens during internship. Subscribe to the channel. Write me questions below and I will answer. And I will see you in the next video.