Cross-Cover

There is no doubt in my mind that cross-cover is the worst thing ever. It's awful. Cross-covering means that when I am on call, as my co-interns (bless their hearts) finish up their work-day, they sign out their patients to me. If the interns have clinic in the afternoon, we start taking responsibility for their patients at around noon; otherwise, we get sign-outs from 4-6pm. We hold these until night float comes at 10pm.

The problem with cross-covering is that we don't know the patients well. Even with a good sign-out of pertinent medical problems, I end up caring for up to 40 patients (usually and thankfully it averages about half of that), and I have this while trying to admit new patients to my service. Theoretically, cross-covering should be minimal. Most of the work during the daytime should be done for these patients, but the truth is, cross-covering can become the worst nightmare. There are the annoying unimportant calls about medications that have to be renewed or itching or "just wanted to check to see what the plan is, doctor." These can get really frustrating because they constantly interrupt us while we're seeing new patients.

But not infrequently, an unanticipated serious problem comes up: chest pain, seizure, shortness of breath, tachycardia, hypotension. Upon seeing the patient, I'm occasionally alarmed by how sick they look or how fast they seem to be deteriorating. Then, there's a scramble to get more help, learn as much as I can about the patient, and prevent him from getting much worse. I've had cross-cover duties tie my hands for hours as I try to resuscitate someone I don't know well.

Unfortunately, there's no great way around cross-covering; it's such a blessing when I'm not on call and I can leave at 4. But I also cringe when I find out that my cointerns were called on my patients, especially if it was unanticipated or unnecessary. The best moment of my call nights are around 10pm when the night float comes and takes away all those sign-outs to let me concentrate on my own patients who I might have neglected as I found myself spread too thin.

Along those lines, I'm still at the hospital, mostly because I'm less distracted here, but also to hold my pager a little longer and prevent one or two unnecessary pages to my co-intern who will be cross-covering my patients tonight.