A Hundred Words for “Tired”

Posted on March 1, 2023 by marylbrandt

It has been said that the Inuit people have a hundred words for snow. When you live in a dangerous environment, it’s important to learn the variations of snow to survive. But, when you look into the origin of the “hundred words for snow”, it turns out it’s not exactly true – Inuits don’t have more words for snow than other languages…Their detailed understanding of snow is a lived, not spoken vocabulary.

The same is true for those who spend nights awake working in a hospital. We, too, have a lived vocabulary that includes hundreds of subtle variations of fatigue, even though we don’t have words to describe them. (The closest I’ve come to being able to describe this fatigue is in “sleep equivalents”, specific events or things that makes you feel like you have had more sleep than you actually did. For example, a shower after being up all night can give you the equivalent of anywhere from 20 to 60 minutes of sleep depending on how tired you are. Brushing your teeth after a hard night of call is usually 5-10 minute sleep equivalent. A good strong cup of coffee can be as much as 45 minutes of sleep equivalent – although it’s important to titrate it so you don’t end up with anxious jitters instead of just being awake.)

Knowing how to manage this level of fatigue it is part of medical training. (Don’t get me wrong… I’m not advocating that trainees must get tired on a regular basis to “learn how to manage it”) Learning to successfully manage the fatigue of long days and nights on call hinges on two things and both have to do with deliberate choices.

Learning not to trust your first instinct if you are sleep deprived is the first important lesson. Even if it’s a drug you know well, or the chest x-ray looks ok, stop and be deliberate. Consciously review the data, look at the options and, for really important decisions, ask someone to look at the situation with you.

The second lesson in managing fatigue is maybe even more important. The bone deep fatigue of medical training is not solely the result of sleep deprivation. When you stay up all night you also lose the liminal spaces of waking and falling asleep, the threshold between night and day. In scientific terms, this means there is a major disruption of your circadian rhythms. But it’s more than just physiology. The drowsy moments between sleep and being awake take place in the liminal spaces of dawn and dusk. We lose more than orientation to daylight when we lose this liminal space. The Irish poet and priest John O’Donoghue, teaches that liminal spaces are moments and places where the spiritual touches the finite. By losing the profoundly important rhythm of rest – including these liminal spaces – we end up physiologically, psychologically, and spiritually unmoored.

You have to be deliberate here, too. By trial-and-error work to find the things that ground you, the things that help you recover in a deeper way than just catching up on the sleep. Make lists of anything and everything that helps you recover from call for the times you are too tired to remember or choose. Look at those lists before you leave for your call day and choose something to do for yourself when you leave the hospital the next day. It might be going to the gym for a light workout, having a great cup of coffee in a cafe, a slow, grateful walk outside, playing with a pet, a hug from a loved one…or finding a way to “play” outside.

May the sacrifice of time and sleep you make for others come back to you as joy … and may you find deep rest in knowing you make a difference in so many lives.

Scientifically Superstitious

Posted on July 30, 2018 by marylbrandt

There is a longstanding superstition in medicine that you never wish someone a quiet call night, sort of the medical equivalent of never wishing an actor a good show. We are trained in science, so all physicians know this is silly…and yet…

There are many theories in psychology about why human beings are superstitious, but the one that I think best explains the superstitions of doctors is that superstitious rituals decrease stress and can improve performance during stressful work.

So, don’t make fun of me when I wear my green socks for Kasai procedures… or when I feign horror if someone wishes me a quiet call night!

Photo credit

Sudden Unexpected Call Syndrome

Posted on November 4, 2017 by marylbrandt

Picture this… it’s 6:42 this morning, my cat is snuggled in my lap, my coffee is delicious, the music is wonderful. And then… I looked at my calendar.

Really?

I’M ON CALL?

Between call and business travel this is the first weekend in 5 weeks I’ve been home. I was totally psyched for a weekend off and then…

If you are in medicine, you will immediately recognize that this is an important syndrome which, up to now, has gone unnamed. If you aren’t in medicine it’s important to know what happens next. When a physician, nurse or other provider suffers from SUCS, it only takes 10-15 minutes to have the paradigm shift of “Oh, well….. “ and then move on to how you are going to take care of others. (Trainees – when, not if, this happens to you, the worst thing you can do is turn this into a chronic condition by letting this torture you during your call day.)

I took a deep breath, reorganized my thoughts and my emotions. I went from my hierarchy of needs for the weekend to the well recognized hierarchy of needs for being on call.

Photo credit

Then I texted my fellow.

And she responded….

On to the rest of the day, including my Saturday tradition of going to the farmer’s market!

As I was at the farmer’s market, looking at all the wonderful produce, having breakfast and soaking in the sun, I pondered my rapid recovery from SUCS.

And then I had a thought I will pose to my readers…. what should we call the opposite syndrome? You know, the one when you get to the hospital and realize you made a mistake and you aren’t on call?

Dancing Doctor Video

p.s. It turned out my call yesterday was listed as an “all day” event for two days on Outlook. Whew!

Top 10 ways to survive (and maybe even enjoy) being on call

Posted on June 10, 2014 by marylbrandt

Like our residents (but not nearly as frequently), my group has started taking “in house” call. For every one who is currently or has been a resident, this is an experience we all know…. and one that’s hard to describe to those that haven’t experienced it. Spending 24 hours on call in the hospital can be emotionally and physically draining, but it has moments that make it a special experience, too.

There are ways to make the experience easier. Here are my top 10 ways to survive (and maybe even enjoy) being on call:

1. Drink water. Put a water bottle in the lounge refrigerator, drink from every water fountain, put your water bottle next to your computer, or come up with other ways to stay hydrated. If you want more flavor, bring a zip-lock with cut up lemons or limes to put in your water or add a splash of fruit juice.

2. Be kind. No matter how stressed or busy you are, knock on every patient’s door and enter their room with the intention to help. Sit down or put a hand on their arm when you are talking to them. Smile.

3. Take breaks. On purpose. No one really expects you to work non-stop for 24 hours and it’s not good for your patients. Deliberately stop to do something else every few hours, even if it’s just for 5 minutes. Go outside for a few minutes for a short walk to catch some natural light and breathe some fresh air. Get a good cup of coffee or tea, listen to some music or just sit. If you want something more active, climb a few flights of stairs, stretch, or even do a light workout.

4. Eat well and eat often. Do not rely on fast food or the hospital cafeteria. By far the best plan is to bring really good food from home. You need to have “comfort” food on call. If you don’t cook, buy really good prepared food that you can look forward to. Make sure you have “plan B” ready if your call day gets completely out of control by having an energy bar (my favorite is Kind bars), peanut butter sandwich or other “quick” food in your white coat pocket.

5. Be part of the team. Notice and encourage the unique camaraderie you share with everyone else who is on call. It’s a small “band of brothers” who find themselves in the hospital at 3am. Be kind to each other, help each other, and use this unique opportunity to get to know someone you might otherwise not get to know.

6. Wear good shoes. If you are in house for 24 hours, bring a second pair that’s completely different (clogs and running shoes for example). Ditto socks. Buy really good socks and change them after 12 hours if you can.

7. Use caffeine wisely. It’s practically essential for many of us at the beginning of the day, but beware trying to “wake up” with caffeine after 2pm. Not to mention that if you “caffeinate” all night, you’ll have that sickly post-call-too-much-caffeine feeling in the morning.

8. Take naps. Any sleep is good sleep on call. If it’s possible, 20 minutes will make you more alert and effective in your work.

9. Make your beeper a “Zen bell”. Use your pager or phone as a tool for mindfulness. When it goes off, take a deep breath, relax the muscles in your face and shoulders and be present. This is a proven practice to decrease stress – try it, it works!

10. Learn. Take advantage of the unique educational opportunity of being on call. The fact that there are fewer people around at night and on the weekends has a real impact on how and what you learn on call. If you are a student or junior resident, you are more likely to be the first person evaluating new consults and admissions. You are also more likely to have one on one time with your senior resident or faculty as you care for patients together. If you are further along in your training, the “down time” on call (if there is any!) is a great time to catch up on reading.

Fast Food for Call Nights

Posted on May 24, 2013 by marylbrandt

It’s 2am on call. All of a sudden you are starving, not to mention craving comfort food. The only thing available is MacDonald’s or (on rare occasions) the leftover pizza from the noon conference. It’s a problem. Eating that kind of food at 2am will almost certainly result in food coma, not to mention that you really know it’s not healithy or what you would recommend for your patients.

Here’s the answer.

These tacos are a great breakfast on the run, afternoon snack or 2am call food. It takes ~15 minutes to make 10 of them on the weekend – which is enough to last for several weeks.

Start by chopping up the veggies you want to put in the tacos. My “go to” is one red bell pepper and a poblano pepper. Corn and rice work well, too. You can change the taste by using different cheese and different veggies (broccoli, carrots etc with Monterrey Jack, for example).

Buy the cheese you want already shredded. Lowfat Mexican is my usual choice, but any cheese is fine. I’ll often cut up a block of 50% Cabot cheddar cheese which is a great tasting low calorie cheese.

Put 10 whole wheat tortillas on the counter and divide one can of refried beans between them. Use nonfat if you are watching calories. Black beans, pinto beans, spicy or not – your choice!

Divide up your veggies and cheese onto the 10 tacos.

Roll them up and put them in snack size plastic bags.

Put the little bags in a gallon freezer bag (important to prevent the bad taste of freezer burn) and put them in the freezer. They last for weeks.

Two minutes in the microwave directly from the freezer gives you a great breakfast, snack, or middle of the night comfort food!

Cold Summer Treats

Posted on June 11, 2011 by marylbrandt

It’s summer and it’s hot. I’m on call this weekend. That combination made me think about cold comfort food I could take to work.

Chocolate (in any form) is always the answer… but I decided maybe I could find something a little more healthy (and a little less caloric) that could serve as the “treat” we all crave when we are working hard on call. I’m thinking the team will like a little Salpicon mid afternoon tomorrow…

Salpicon – a sparkling fruit drink from Columbia

This soup looks delicious, but with the heavy cream probably isn’t in the “low calorie” list. You can substitute milk or yogurt to cut calories (without too much sacrifice of taste). But, then again, as an on-call treat this still beats McDonald’s! This is just one example of cold soups – which are great for summer on-call days.

Cold avocado soup

Smoothies are great comfort food – but logistically not easy when you are on call. If you love smoothies, you might want to invest in an inexpensive single-serve blender. Take the fruit in a baggie, put some yogurt and ice cubes in… instant smoothie. Alternatively, you can blend your smoothie at home and put it in a container in the refrigerator that you can shake up before drinking.

Banana mango smoothie

Healthy Habit: Get Moving!

Posted on February 4, 2011 by marylbrandt

One of my New Year’s resolutions was to come up with monthly “resolutions” for myself and for anyone who follows this blog. Cooking Light magazine (which is one of my favorite sources of recipes and ideas for healthy living) had the same idea, so I am shamelessly borrowing their healthy habits!

Cooking Light’s 12 Healthy Habits

It’s a lot easier to commit to 30 days of a new habit than a full year. So this month’s goal is to maintain or improve fitness by increasing activity.

It may seem daunting to stay in shape or even improve your fitness level when you are swamped with studying or work in the hospital. It’s not easy, but it is absolutely doable. The best way to start is to pick one or two of the following ideas and make them a resolution for this month. Pick goals that are “SMART” (Specific, Measurable, Attainable, Realistic and Timely) and then just do it! Consistency is the most important part of setting this goal – so pick something that you know you can do on a regular basis.

Some ideas to consider:

Take the stairs at work instead of the elevator
Commute to school or the hospital on your feet or on a bicycle
Park as far away from school or work as is reasonable and walk the rest of the way
Plan ahead for 10 minutes of exercise while you are on call and take what you need
Wear a pedometer and get 10,000 steps/day
Do push-ups every morning before you go to work
Find a cardio exercise that isn’t boring for you and do it 30 minutes 3x/week
Run. It’s easy, it’s cheap and it’s the most effective exercise for busy people!
Hire a trainer for one workout a week (or ask for this as a present)
Play golf, tennis, racquetball – any game that gets you moving!
Find a spin class or other organized exercise class to attend once a week
Organize a basketball or ultimate Frisbee game with your friends once a week
Shoot for a total minute goal/week of exercise (start with 100?) and keep track
Whatever you decide to do, PLAN – make it an appointment on your calendar, put it on your daily scut list, get your clothes out the night before – do whatever it takes to make it happen!

Tour de France Rice Cakes

Posted on July 16, 2010 by marylbrandt

I’m addicted to watching the Tour de France. It’s an amazing athletic event, and the images (at least on HD) are simple astonishing.

There was a really great “side story” on tonight’s Tour broadcast about Dr. Allen Lim, a PhD sports physiologist. The segment was specifically about his rice cakes – a real food equivalent of a commercial energy bar used by the Radio Shack riders. http://dailyburn.com/recipes/dr_allen_lim_rice_cakes.

I haven’t made these yet, but I’m pretty certain they are going to be really good and – more importantly – a great call/energy food for busy students and residents. He has some other recipes that would probably be good on call energy food, too

Here’s a video on how to make these rice cakes. http://www.cycle-ops.com/videos.html?id=50

Photo from http://bikefleet.blogspot.com/2009/03/allen-lims-rice-cakes.html

Healthy Sandwiches

Posted on July 8, 2010 by marylbrandt

Making a healthy sandwich for lunch is a great way to insure that you don’t eat the leftover pizza from last night’s call team. A really good sandwich which balances protein and carbs is also a great way to get through a long call night. Keeping your energy up when you are up all night on call is difficult but there are tricks to maintain energy for call. The most important way to have good energy on call is to eat good quality food every 3-4 hours. Sandwiches are great for call because they are so easy to make, easy to store and easy to put in a pocket to eat on the go.

Pick good ingredients whenever you can. It’s worth paying a little more to have food that is just food (and not a lot of fillers, corn syrup, transfats, etc). Make sure you get high quality bread – 100% whole wheat is best, but if you really don’t like whole wheat, at least try to get as much whole grain in the bread as you can. Whenever possible, add veggies to add nutritional value.

Peanut butter sandwiches have the advantage of not needing refrigeration. You can keep them in your white coat pocket if you want to (an advantage on a busy day). You can stay traditional (i.e. peanut butter and jelly), or up the nutritional content by adding banana (or other fruit) or with other unusual combinations.

Egg salad sandwiches are great in the middle of the night when you are on call. 101cookbooks.com egg salad recipe is a pretty classic recipe which is really wonderful. If you want to up the protein and decrease the fat leave out some or al of the egg yolks and use lowfat mayonnaise. There are other options for traditional egg salad recipes, too

Tuna or chicken salad sandwiches can be made with classic recipes, or less traditional ingredients that up the nutritional content such as spicy tuna salad, or other unique tuna salad recipes.

Lean meat (chicken, ham, pork, beef) makes a great, high protein sandwich. Add cheese, tomatoes, spinach, shredded carrots or other veggies to increase the nutritional value. If you are watching your weight use low-fat cheese and avoid mayonnaise. If you use hummus or avocado instead of mayonnaise or other spreads you’ll also make the sandwich more nutritious.

Here are a few other sites to help you be creative with your sandwich ideas:

Healthy Sandwich Recipes & Tips

Love Your Lunch: 10 Healthy Sandwich Recipes

Good Nutrition is in the Bag: Healthy Sandwich Alternatives

You Can Exercise Even if You are on Call

Posted on April 7, 2010 by marylbrandt

One of the great fallacies about working out is that you need to “go somewhere” to work out. This idea that working out is separate from the rest of your life is the main reason people don’t work out. Be creative – there are lots of ways to work out that don’t require much and can be done in the hospital. There are days on call and then there are days on call (everyone who has done it knows what I am talking about). On the days that have a little “breathing room” here are some ways to work out while you are at work.

Cardio options

Take the stairs instead of the elevator. There are good data that 3 sessions of 10 minutes of cardio has the same result as a 30 minute cardio session. Those 2-3 minute “sessions” of going from floor to floor will add up to 20-30 minutes easily by the end of the day. Or, if you want to push it a bit, add a few flights (or minutes) here and there. You can always find 10 minutes (or 20, if the day permits) and really climb the stairs.
Take a jump rope to the hospital and keep it in the call room
Find out if there is a stress test lab or PT area in the hospital that has stationary bikes or treadmills that you can use.
Go for a walk. If it’s safe, and your beeper and cell phone permit, walk outside the hospital. If not, do “power rounds” on the floors for exercise (do the circuit of each floor, climb the stairs to the next floor and continue).
Talk your program into paying for a used bike or treadmill.
Commute to work on your feet or on a bicycle (more on that later…)

Strength training options

Buy a set of stretch bands or inflatable (with water) dumbbells and throw them into your on-call bag. You can get a good strength training workout with these.
Cheap dumbbells are easy to find. For $20-30, you can put a pair or two in the call room or resident lounge. See if there are other residents that want to go in with you to buy a complete set. Of course, you will have to find a way to lock them up if, like most hospitals, things have a habit of walking away.
Old fashion calesthenics (push-ups, squats, etc) will provide a good strength workout , too. You might consider one of the many popular DVD based programs that are making the rounds (no pun intended) at the moment.

Flexibility training

Stretching can be done anywhere, anytime. Like weight training, there are some good tips that can be taught by a pro. Make sure if you hire a personal trainer that you ask them to give you some tips about stretching, too. There are also excellent books on stretching. You might think about web based or DVD yoga sessions as another alternative.

The key concept here is that working out during call is doable – and will often help with fatigue, stress and the feeling of being overworked. These “workouts” don’t have to be long – even 10 minutes will help.