June 18, 2011
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Being on-call.
Being on-call is such a bittersweet thing.
The pros are that:
- it is extra money each paycheck that I definitely like.
- the more people who do on-call on the evenings and weekends means the less time each person needs to be on call overall, so I’m glad to help out, especially since I don’t do on-call during the work day.
- some nights you don’t get any calls!
The cons are most definitely that:
- sometimes you go in for one person and get to stay for two. (sort of a pro in a way).
- sometimes you really don’t get a lot of sleep (last night I got to sleep between 11PM and 12AM and then again from 2:30 AM to 5:30AM
- you feel like a slave to the pager and you can’t get too far out of range of the hospital and jail and most definitely not out of cell phone range.
- it can make you feel really inadequate when you are the “professional” who is supposed to have all the answers and you don’t.
- being a mental health professional on-call means you have to make judgments about whether to pursue involuntary mental health commitments and that is no easy job.
- sometimes you get bitter about what you’re doing when you get called for false alarms (like someone is suicidal but drunk; they don’t need me at that point and sometimes the docs will have me called before a BAC is done – NOT COOL)
- you realize how many people here have serious issues. It is so sad how much medication-seeking/doctor-shopping and substance use goes on here. Heroin is on the rise because it is cheaper than Oxycontin on the street. At least no one injects Oxy.
Sigh. No real point to this entry other than just to vent. I was on-call yesterday, from 8PM to 8AM today. I agreed to take the evening half of today’s shift from the guy who’d already signed up for it but needed to give up the evening shift. I told myself I wouldn’t take two days in a row on the weekend again — but here I am exhausted from the lack of sleep last night and it’s only an hour til I have to turn on the pager again. Here’s to hoping tonight is calm. (BTW, this is exactly what our pagers look like)
Comments (8)
I had that same pager once upon a time. My first hospice job required me to be on-call. The money was sure nice, but even if you don’t get called, you’re always on edge and you don’t really sleep all that great. Then when you hear the pager go off, your stomach sinks. I remember those days well and they are not easy. Can you imagine being an OB/Gyn? I can’t imagine being a doctor and doing that all the time!
@ShamrockLover - Nice! You’d think that we could get slightly more updated pagers, lol. We get paid $100 for a weeknight, $150 for weekends. Weekends you actually get sort of screwed, because those shifts are 8AM to 8AM the next day for only $50 more than a weekday where you’re only on call from 4PM to 8AM! But, you also run the risk of being hella tired for work the next day!
The stomach sinking thing is totally true. My immediate involuntary response every time it goes off in the middle of the night now is “shit, mother f*cker.” I hate to admit that, but it’s true. BUT, someone has to be on call and I know it is a very much needed service. I always feel better and less bitter about being woken up once I’m there doing my thing, but that initial reaction is not pleasant!
I can’t imagine being a hospital psychiatrist either. We have to consult with them at all hours too. Of course, they get to stay at home where as I have to go in. I also feel bad for the judges around here. Since Alaska is so spread out, I sometimes have to call a judge in Ketchikan or Sitka to authorize an ex-parte. They could be getting calls from all over Southeast Alaska from other mental health professionals in other cities the same night I’m calling them.
So, you just get a flat amount no matter how much you get called? I remember making $30 a night, but if i actually got called and had to go in, i also made my salary for the hours i put in. I’m not sure which is better, but i liked the feeling of getting paid more if i actually got paged….made it seem worth it almost…lol. And i totally forgot about the nights you have to be on call and still work the next day! I remember if i got called, i could come in an hour or two later, but i was still tired.
@ShamrockLover - Yeah we just get a flat rate. When you don’t get a single call that’s awesome, but it totally balances out those nights when $150 does not seem worth it! I’m sure we could come in late if you had a really late night — but most people tough it out. I’m looking forward to having yet another new person coming on soon, so that’s one more person to spread the on-call schedule with. It’s especially more difficult in the summer when everyone is going on vacation.
Can you explain why someone drunk and suicidal is different than just suicidal?
And I’m pretty sure people inject oxy.
@PennyLumpkins - First — oh I’m sure people do inject oxy, but here it isn’t nearly as common. I wasn’t very clear there, working on only four hours of sleep.
Second — Sure! So, if we’re making our case to ex-parte someone (involuntarily commit them against their will for a 72-hour hold), it is because their mental illness (not substance use) makes them a danger to themselves, to others, or they are experiencing “grave disability”/significant psychosis. If someone is intoxicated, we cannot be sure if their symptoms and presentation is the cause of the substance use, the mental illness or a combination of both.
Here, if someone is intoxicated or high and needs to be kept safe a doctor (without the help of an on-call person) can send the person to sleep off at our local correctional center after they’ve been medically cleared or to detox on the mental health unit. If, in the morning, they’re still suicidal, homicidal or gravely disabled and are now sober, we’re sometimes called in to assess them then and perhaps seek an ex-parte order then if they’re not willing to be voluntarily admitted. But, most often once they’re sober in the morning they’re able to be released.
It’s a sticky, grey area in general. A high high percentage of our mental health system recipients do use substances and it can be really hard to know what it what. I saw one person who had been drinking, but had a low BAC (more than .08, but less than .2). While that person was likely intoxicated, their presentation was CLEAR to me that they had other psychosis going on and I was confident that by the time they were no longer “legally intoxicated” they would STILL be talking about the bizarre things they were talking about.
Well if it makes you feel any better now I know how my team feels and I’ll be more understanding. Even if you’re not benefiting from it. lol. I hear them complain a lot too. Mostly because my team HAS to answer calls no matter what, from patients themselves and more so then not we have a lot of lonely people who will call at like 2am to ask them what they should eat for breakfast. Or the guy who went to the ER EVERY single night for 6 months straight. Till his insurance kicked out. lol.
@FallingSafely - Yes, those of us on-call don’t mind being on call for legitimate reasons, but the other calls can really drain you quickly. And sometimes I don’t like being on call because of the doctors at the ER – not the patients!