Thursday, November 11, 2010

Block 5: MICU float/Nightfloat

(This is one installment in a series of posts about what I do on a day-to-day basis as an internal medicine resident. If you are interested in the others, you can find them here: Block 1, Block 2, Block 3, Block 4.)

This month I did two things, MICU float and Nightfloat.

Some of you may not know about the many rules that guide the work hours of residents. They are very complicated and frequently change but the 3 big ones are:

--Over a 4 week period, each resident should work no more than 80 hours per week on average. Some of the old school docs think we are big wimps because we "only" work 80 hours a week, but a few years ago the powers that be finally came to their senses and realized that doctors are human, and humans tire, and when we are tired we make mistakes. And we can cause big problems when we make mistakes. Despite my frequent referral to us as factory workers, us making mistakes is a bit different than when you get home and realize they forgot the fries to go with your Big Mac.

--We are only supposed to work 24 hours in a row, with a 6 hour buffer time to finish tasks. In reality, this means we can work 30 hr shifts. One of the (many) reasons that Northwestern is a wonderful residency program is that we only have to do these 30 hours shifts in our ICUs, not on our general medicine wards. Most other competitive programs have 9 months of every 4th night overnight call. How....freaking.....awful. These rules are changing again next year and soon we will only be able to work 16 hours shifts. (But I'm done this year, so what do I care?? ;) )

--We must average 4 days off in any 4 week period. Yes, that means we usually work weekends. A two-day weekend is rare in our pitiful little lives.

So, how does this tie in to MICU floating? In addition to having very infrequent 30 hour shifts, Northwestern's Internal Medicine program is ADAMANT in their compliance about this rule, which is great. We never go over hours. In an ICU setting, however, there is no way to get all the day's work done in time to get out by 1pm (call starts at 7 am the previous day). So we have extra bodies who come in at 7:30 am, round with the post-call team, and do some of their work for them. So that's what I did for part of this block. Got to work at 7:30, rounded with the post call team, helped get them out on time, then baby-sat their patients for the rest of the day while they went home to sleep. This can be kind of fun because you don't really have that much work to do (you are there for emergencies, crashing patients, etc) so it's a good time to socialize and be grateful that you are just floating and not actually in the MICU for reals! (Read the MICU post here).

The other half of the month, I was on Nightfloat again. I've written about this before (see here), so won't go into detail. I will say that this was one of my more fun Nightfloat weeks.

Below is the Nightfloat crew shooting the breeze, ahem, I mean, hard at work;) We had some good talks about what we would do if we didn't do medicine- we had votes for wildlife photographer, meteorologist, lab researcher, professor, and oil tycoon. Most of us agreed, however, that it would be best to just win the lottery and retire:)

We celebrated She-Yan's b-day twice - once at midnight on b-day eve and then when we came back at 7pm that day. We ate some pizza, we ate some chicken tenders. We had a LOT of coffee. We listened to Pandora, had 80's hour, got in some YouTube viewing. We gave each other clever (or so we thought) nicknames. Oh- and we admitted 3-6 patients each every night. No biggie.

Here's the Nightfloat resident crew:

...and the interns:

I know we look happy. And we mostly were. Just generally not between 2-6 AM. Only 1 night left!!


  1. Those work hours are insane! I don't know how you do it. I bet you form pretty tight bonds with your fellow residents - I'm curious to know what your clever nickname is:)

  2. Well, at least you're keeping a good attitude! I have to confess that when I started to feel sorry for myself in anesthesia school (which is pretty brutal in its own right) I would go chat with our residents and give them a break (if you're the main anesthesia provider in a room here you don't leave the room unless another provider comes in to relieve you, and since they're usually in their rooms, you can go hours and hours with no break).

    Anyway, it always put things back in perspective for me. And if you love what you do there isn't anything else, is there? Although I will admit that if this anesthesia gig doesn't work out I might consider becoming an artisan-style baker!

    Hang in there - you're almost finished!