I’ve been wanting to write more about my experience with call shifts so far but finding it difficult to know where to start. Then, I had this idea that maybe a good place would be to explore how I prepare, both externally and internally. So, Part I today focuses on external prep (which, in my opinion, is a lot easier, although it still takes a while to find your groove, I think. At least it did for me).
I’ve been taking call now since April, and according to Typhon (ah, Typhon!), have logged about 230 hours of intrapartum call. I mention this, because 230 hours seems like a lot…and most days I still feel like I’m just barely keeping up. Just in the past week, though, I feel like I’ve turned a little corner…it’s amazing how having a routine really does seem to help.
So, without further ado, here some of the concrete things I do to get ready for call.
1. Get sleep! As much as possible. I don’t take 24hr call yet. In theory, I could choose to if I want, but for my own learning, I’ve found that 12hr shifts are plenty. Yes, sometimes it means I miss those near shift change births…but I would rather those mamas have a fresh team, ready to jump in, than be worried that my fatigue might contribute to an error. Those babies are going to be born no matter who is there–it’s really not about me at all.
If I’m on for a night shift, I sleep in as late as I can and try to take it easy during the day. If I can’t sleep in, I’ll try to get a nap in from 3-5ish. It’s a tough balance, because sometimes it’s slow and then if I slept a lot during the day, I can’t nap well in the call room. But, I always err on the side of more napping rather than less. For day shifts, I’m in bed the night before by 10 at the latest. I have to be up, showered, dressed, coffeed and walking out my door by 6:20 on a weekday, 6:30 on the weekend to arrive in time for report.
2. Pack food! Easier said than done at the end of the term when I’m pooped and just heading down to the cafeteria sounds so easy…but especially as a pregnant midwifery student, I need more than cafeteria BLT’s to keep my energy up. I try at minimum to bring a sandwich, some fruit, yogurt, and whatever leftovers might be lying around in the fridge, so that’s two meals I don’t have to buy. Also, my call bag is always loaded up with Lara bars. I try to keep a stash of crackers in my bag, and bring cheese and apples as a quick snack while charting. We SNM’s also do a pretty good job of keeping our own stash of chocolate in the SNM cubby above our desk.
3. Speaking of call bag…I don’t know how other people do this, but after a term and half of trying different things, I’ve found it easiest to have two. The one on the left (my beloved Linus bike bag, which hasn’t actually been on a bike in a while now…), is always packed with a spare set of clothes, toiletries, my stethoscope and a few sets of sterile gloves, along with my food and water. The other bag (a conference bag that’s actually useful!) is the one I’ve been using to shlep school stuff in: books, laptop/iPad, my planner, papers…
So what all is here?
- After trying it both ways, I’ve found it easier for me (read: more time to sleep in) to bring a clean set of scrubs home with me so that I can come to my call shift already in scrubs. Door to door, I’m 20 minutes from the hospital without traffic…so not having to get there early enough to change into scrubs means an extra 10 minutes of sleep! Unless my scrubs get messy on a shift, I come home in scrubs, shower right away at home, and return the dirty ones on the next shift.
- The little black moleskine notebook is where I jot down lab values I need to work on memorizing, protocols and/or questions I have–basically things I want to look up later. It does not contain any identifying patient info (that’s kept on my brain, and tossed at the end of each shift–see below).
- Pager and stethoscope, of course. Also, Lara Bar. Always.
- Toiletries. Never underestimate how a quick toothbrushing and some deodorant can perk you right up after a night call nap!
- Fetal position wheel…this was a gift to all the first year SNM’s from the Oregon ACNM affiliate and it’s come in handy for both myself and for patient teaching. Basically, the little fetal head rotates on the card, so as I’m palpating sutures, I can adjust the head on the card to reflect what I’m feeling, and then use it to help explain to laboring patients what their baby’s position is. It’s always in my pocket!
- Suture kit. I always throw it in my bag for the slow days, so I can practice knots. I’ve got a stash of sutures and felt in there, too, and in the call room, the SNM’s keep extra yarn and one of those Ethicon practice boards. I haven’t actually used it a ton…but I like being prepared.
- Reference books. The two I always bring are Lisa Miller’s Fetal Monitoring book and Lauren Dutton’s Clinical Midwifery Pocket Guide. I used to bring my Oxorn and Foote, but there’s a copy in the call room, and it’s a bit bigger, so I don’t bring that one with me anymore. Feminist Midwife posted a photo a while back on Facebook of her copy of Dutton’s Pocket Guide…mine is rapidly approaching a similar “full of post-it’s and written-in notes” appearance. I’ll often go directly from jotting questions in my moleskine to looking up quick answers in Dutton, and then make a list of follow up things/articles I want to look up back in the moleskine.
- Water and coffee thermos. ‘Nuff said.
Other things not photographed:
- Laptop/iPad for getting schoolwork done on slow shifts (sometimes, especially at night, I’ll stay home because I’m so close…but often there are 2-3 hr lulls when it’s nice to have my own computer to work on stuff).
- Copies of my CNM Brain (Lena’s IP Brain_Summer2015).
- My clipboard with other reference docs I’ve created for both antepartum and intrapartum (again, on a slow day, I like to review algorithms, etc. More on that in Part II!).
What do you all bring to call with you? What’s your pre-call routine? I’d love to hear it, either here in the comments or on Facebook!