Thursday, September 24, 2009

Post-Call Thursday

Yes, I was done with call on Monday. But every once in a while, Saturday is so bad, the aftereffects last well into the week.

Last Friday, I began to worry when the transcriptionists, flow techs, and histotechs; all the lab personnel that were receiving the specimens and preparing them for me to look at on Saturday, started saying things like:

"You had better eat your Wheaties tomorrow morning!"

"I hope you have some Valium to take tonight at bedtime!"

I didn't do either, but I did get up and run Saturday morning, in mental preparation for the onslaught. And I haven't run since, an unprecedented length of non-exercise for me in the past three years, cause I have been plain wore out. Putting together bone marrow and lymph node cases is the pinnacle of specimen puzzles - it takes clinical history, radiology, immunophenotyping, flow cytometry phenotyping, and often molecular genetics (FISH, PCR, conventional cytogenetics) in order to pull it all together. And I wasn't really trained in this area, unless you count the 30 myeloma bone marrows I counted plasma cell percentages for one disease, multiple myeloma, during my three months of hematology. One of those months I was extremely pregnant, and I remember the then dictator-like ruler, who suffered from bouts of mania, threatened to install a port-a potty in the heme sign out room so he could keep tabs on the residents at all times. He was serious. I think he actually looked into renting one.

Luckily, I have only had three Saturdays with this degree of work since I have been here. And I get nine a year. So that's only about 16%, according to the calculator I use to figure cell count percentages in the blood and bone marrow.

I did come up to work after the kids went to bed Sunday night, and again on Tuesday, to finish up some cases without daily distractions from the phone, new cases, frozen sections, etc. It is usually dead quiet in the lab at night, so much so that it reminds me of being in med school, studying in the basement of ED II all alone in a classroom in the middle of the night, when I would drive myself to paranoia thinking about stories of lost hoodlums finding their way from the ER to education buildings to commit crimes out of boredom. I think I was just distracting myself from the task at hand, studying, with the entertainment of fear.

Strangely, it was not so quiet on Sunday night. Babies crying, people talking - I finally got up to take a break and pay a bill in the main lobby of the hospital and passed through the lab-draw waiting area, right down from my office, which usually holds five to six adults at the most, during the day, and is never occupied at night. I was shocked to see all of the chairs full, 20 or 30 people at least, at 10 o'clock at night, slumped on the brown pleather couches staring at CNN, two thirds of whom were wearing surgical masks. I reflexively held my breath, like when I pass by a graveyard (to prevent evil souls from trying to inhabit my body - some leftover childhood ghost story) or through an underground tunnel. I wondered if I had been so occupied with my call that I had missed the newest pandemic, and vowed to check the news when I got back to my office. As I was returning, I still held my breath but slowed down a little to take in the listless faces, all of whom stared quietly, mouthless.

The next day in micro q/a after we had covered molecular and the latest on the H1N1, I asked, "What is going on in the lab waiting area at night?"

The emergency room is being renovated, and it is now a fast-track ER waiting room, holding patients triaged for less emergent needs. Makes sense. I guess the face precautions for fever/cough are either still in place from the spring, or were never removed.

So when I was up again late on Tuesday night, I paid better attention and watched a nurse stick out her neck from a door I was certain, previously, served no purpose in the last two years, and yell, "NEXT!" Better yet, I can now hear all of this from my office. No more nighttime quiet. There were a lot more screaming babies on Tuesday, and those seeking more privacy to work out their personal problems tend to gravitate down the hall, right outside my office. For example,

"Did you see who threw that brick through the window last night? Almost hit the television! I thought --- was back in prison! Now who in the hell are we going to get to take --- to school tomorrow? I'm going to have to deal with all of this for the next few days."

OK, so I am omitting many expletives. I also heard a melodramatic, Jerry Springer show-like relationship fight. I no longer need my own imagination to entertain myself here at night. Hopefully I won't have to be up here again late for another few months.

I finally got the last problem case shipped off to Boston yesterday - the only one I couldn't finish without outside consultation. I was happy to climb into bed at 8:30 last night and read a novel until after 11:00 - brain candy, I can't remember the author, but of the British loser girl turns successful Cinderella variety. I'm glad that call is over, and I can't wait for the weekend. But a little part of me is missing the high from all the work. It felt good to tackle all those challenging cases - for both the learning curve and confidence level. God knows I need all the help I can get in the latter arena.


ts said...

i was also busy the friday before i gave birth...i stayed at work until 6pm and left several cases on my desk, planning to come in on sunday to finish up. but, baby boy had other plans and i had to ask chris and paul to finish them up for me. i hate "dumping" cases like that! i guess you can never plan birth...

Gizabeth Shyder said...

My worst was when I got mastitis and Dan took my call -- I think he got 6 autopsies!!!