Call at the Valley

Call at Santa Clara Valley is exhausting. Even though the shifts aren't long, it can be much more tiring than calls at other hospitals or on medicine. We arrive at 3pm and finish up cases or tackle add-ons. At around 5pm, we try to cut down to only two simultaneous operating rooms. By now, the add-ons start piling up, and around that time we start covering obstetrics as well. We have 3 attendings and 2 residents in the late afternoon and by 10pm, we're down to 2 attendings and 1 resident.

There are a lot of add-ons at Valley, and I'm not sure why; we see a lot of appendectomies, ectopic pregnancies, orthopedic injuries, and other urgent cases each night. There is a considerable amount of trauma at Valley so we have to be ready for a big surgery at any time. The on-call anesthesiologists also split up pre-operative evaluations for any inpatients for the following day so in between cases, I run around the wards to see patients and rifle through charts.

However, Valley call can be tiring because it involves a lot of things that first year anesthesiology residents haven't seen yet. We get the occasional pediatric case, and although attendings help us greatly for these patients, it's something I am less prepared for and less comfortable with. We hold the code pager, and there are a surprising number of code blues requiring intubation. I'm always supported by an attending, and the nurses, pharmacists, and respiratory therapists are outstanding in helping us with equipment and drugs.

The biggest challenge, however, is labor and delivery. I had not been up to L&D since third year of medical school, and relearning the nomenclature, pertinent aspects of pregnancy, and common peripartum illnesses took some time. But it is the place to learn about epidurals. These are still tough for me; I still struggle to find the best entry point, but once I'm in the right place, I've gotten more facile at the technique of placement. There's a lot of learning on call and even though it's very busy, I really enjoy it.