I’m on a 24-hr call. I’m sitting in the small, windowless room that serves as our sleeping space on call, in which can be found a computer (of course a computer, always a computer), a bottle of Purrell foam, a red-topped canister of Sani-Cloths Plus germicidal wipes which features on its front a picture of both an adult and a baby with a red line through them as if to say: not for use by either diapered or continent humans, a programmable safe like the ones you find in hotels (as if anything of value really exists in this life beyond your own breath), a desk lamp that doesn’t work, a bulletin board with no tacks, a breast pump, and a bed made in all white with one thin fitted sheet, one thin flat sheet, one thin blanket, and one thin pillow in a thin pillowcase, as if to say: so too will your sleep here be thin. The walls are blank. The overhead light is bright and garish, but someone, in a touch of gentleness for which I am always grateful, decided to install a wall sconce with a soft, low light. So the inevitable calls do not wrench you from quiet darkness all the way into hospital fluorescence. Instead you flip on the mood sconce which affords just enough light to log in to the computer. Always the computer.
I’ve been taking 24 hour call for several years now — in total I’ve probably done it somewhere between 100-150 times, but every time I’m awake for almost an entire turn of the Earth, it’s newly shocking. The most challenging part of call is the way your physical being can be stretched, like a round of dough that you roll thinner and thinner until a hole opens up in it, but the hole almost never opens up, because you are trained to cohere. When I am on call, it is evident to me that the mind is a part of the physical realm, as susceptible to fatigue as the gastrocnemius or the bicep. The spaces between your thoughts get longer and longer. The two ends of the circle of a thought suddenly, for a split second, don’t meet. And then you force them to meet again and continue on.
The interesting thing about working in the ICU for 24 hours is that it is when you are in the best position to understand the lived experience of your patients’ families. They are at the bedside at all hours of the day and night, sleeping on cold, vinyl recliners under the same thin sheets and blankets. They may or may not be in fresh clothes in the morning. They might have had a granola bar for dinner and then again for breakfast. No one can ever truly understand the way it feels to keep vigil over a beloved, sick child until such a thing happens, and may it happen to as few people as possible. But in my 20th hour of being awake, my hair flying out in every direction in rebellion from my ponytail, my scrubs crumpled and stained, when I come to a bedside for the umpteenth time and there again is the mother, in an oversize man’s T-shirt and no make-up, knitting a pink hat as her tiny baby’s rib cage is expanded and contracted forty times a minute by a ventilator, I feel that we have at least shared a small leg of the journey. When I’m on for 24 hours, we can write the narrative of that day together, whether it’s the first or the last or just one of a number that we all hope will be uncountable. This is one of the reasons I count call among my secret sacred rituals: because why should you always get to go home when they do not.
It’s 12:57am now, and every word written is a second of lost sleep. Outside the call room, workmen are painting some kind of chemical on the floors. I am reminded that all kinds of people work at night, for all kinds of reasons — there is really nothing all that special about it. The chemical is irritating my mildly asthmatic lungs and in the light fog of call I am perseverating on the possibility that I will be poisoned in my sleep. I open the door to inquire about the chemical and find that they have strung masking tape across the door jam at eye level and again at hip level, such that I am unable to exit. My most visceral association is with police caution tape and for a moment I entertain the question of whether, in this imaginary universe, I am the criminal or the corpse. “But I have to respond to codes!” I say, which is really just my cover for the claustrophobia that the tape evokes. “Sorry,” the man says. “Those are the regulations. So you don’t fall.” I am flummoxed. Are people getting taped into their call rooms all over the hospital, I wonder? Is there a job aid that stipulates how many pieces of masking tape are required to barricade the average medical provider? But he has his imperatives and I have come to learn when a thing is just not going to change. I close the door again and it’s back to the temporary universe of my call room, the room that is everyone’s and no one’s, to await the next inevitable thing.
Wow you guys have a breast pump in your call room? We have one that is “reserved” for breastfeeding resident, but that’s because it has a fridge. Breast pump is supplied by the resident. Had to laugh about the flor cleaning. Fortunately (?) we have carpeting in the hall outside our call rooms, but I could definitely imagine carpet cleaning happening at 1Am some night.