Surviving your first 28 hour call

Updated: Jan 31

Before intern year, I could count the number of all-nighters I've pulled in my life on one hand. Now I regularly flip between nights and days and will have MICU rotations that require me to stay up for >24 hours every 4 days. On these days, I get into work at 6AM for my usual day shift, then get sign out from the rest of my team before they go home for the night. Fortunately, we have great in-house support at nighttime. I have a co-intern from the 2nd teaching MICU team, a senior resident, night MICU fellow and attending. However, as the night intern you are responsible for following up labs, placing orders, admitting new patients and helping run codes for all of the patients on your service.

While these rotations are only 2 weeks long, it is still very mentally and physically exhausting to stay up for an unnatural length of time, only to repeat it again in a few days.

Here are my tips to help you get through your first 28 hour call:

Hydrate. Eat. Rest

You must prioritize taking care of yourself first. Don't give yourself an AKI by forgetting to drink fluids or not using the bathroom. I like to carry a few Liquid IV packets, which are electrolyte drink mixes similar to Gatorade, with me to mix with my water throughout my shift and will also bring a can of La Colombe coffee and Celsius Energy Drink (kiwi guava is the best). For food, I'll pack snacks to have throughout the day, and often times we will order dinner as a group. Eating a team dinner gives you something to look forward to and is always a nice break!

Rest and sleep are very important during your 28 hour call shift. If you can sit and not stand, sit. If you can lie down, lie down. We are required to have a 45 minute break, but often times we will grab some blankets, sit in the recliner in our workroom and close our eyes if there is some down time.

Pack a call day bag

My bag consists of the following:

Check in with nurses and patients at shift change

One of the best things I've learned as an intern is to take a computer on wheels and do my own rounds at least one time when the nurses change shifts. This allows me to check in with the patients, introduce myself to the night nurses, and ask if they have any questions or concerns. I can place orders on the spot and update the nurses with any changes to the plan. Starting the night shift with everyone on the same page eliminates delays in patient care and communication. If I have a patient who's a "watcher," I will park myself outside of their ICU room with my computer until the situation becomes more stable.

Post-call day

Often times when I come home from a 28 hour call at around 9-10AM, I feel like a zombie and almost immediately go to sleep after eating a small meal. As someone who loves to sleep, I can easily sleep for 8+ hours post-call. However, I've found that setting an alarm for early afternoon (1-3pm) allows me to maximize my post-call day time and also makes me tired enough to go to sleep at a reasonable hour that night. This schedule helps me get back to a regular circadian rhythm so that I can function at work the next day.

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