TILIR #4-5: On call

Oof. That was painful. So painful it took two days to recover enough to post this.

Last night I took call for the first time in my medical career. There's some confusing nomenclature here. When we cross-cover and work in the hospital over a weekend, we sometime refer to those shifts as call shifts. If we are working nights, then we might get Monday off because we are "post-call."

But what I did last night was more of what the average person thinks of as being on call. I was at home. I had a phone. If anything happened in the hospital's newborn nursery and required a doctor, they called me. If I can handle it from home, I can give advice or put in orders from my computer. However, if a baby were sick enough, I would have to throw on some scrubs and drive in.

As is often the case in medicine, this could result in wildly different nights for me. Either I get a couple of calls but otherwise a pretty normal night's sleep, or I'm basically working a full night shift between two normal day shifts. There is a rule in place that if you have a rough night, you can ask an attending physician to excuse you from your morning clinical activities to get some sleep. But we try not to use that excuse unless we really have to.

Last night I got 7 different calls, plus two other times I got up on my own to check on a lab result. I  slept maybe 5 hours but broken up so that the longest stretch was a little over an hour. I was so tired today that, for the first time since my surgery rotation in med school, I briefly fell asleep standing up. 

It's neat that I have advanced enough to be trusted with this responsibility. But if I'm going to stay up all night, I think I'd rather it just be in the hospital working. Thankfully, most of my top choices for careers after residency, do not include home call.

YIL: There is no current treatment for RSV infections other than supportive care, but there used to be. Ribavirin is an antiviral chair used to treat numerous viral diseases including hepatitis C, various viral hemorrhagic fevers, and, until recently, RSV. Studies done on the drug showed that it was not super effective at decreasing symptoms or hospital stays due to RSV, it was crazy expensive, and there was some concern about occupational exposure to nurses, with this drug having some association with birth defects in pregnant women. The big factor however, seemed to be the extreme cost for little benefit. It is still FDA approved, but only rarely used for immunocompromised kids with known exposures to RSV.

TIL: Adenovirus is the main virus being researched for use in general therapy. It was picked because it is one of the few viruses that targets multiple, disparate organ systems. Unlike for example RSV which targets the lungs and airways, or rotavirus which goes after the GI tract, adenovirus hits both those major systems plus smaller ones like the eyes. The biggest hiccup in this plan is that it has proven really hard to separate the infectiousness of the virus (which we want) from the pathogenicity (which we don't).