On April 16, 2024, I took night call for the last time, 64 years after I first took night call. For the last few months, I have been thinking about all of the changes I have seen relating to the nature and content of my time being on call.
After my first year at Harvard College in 1959, my mother—the chief technologist in a hospital hematology lab—thought it would be useful for me to get training as a hematology technician during the summer so I could get a job when I returned to school in the fall. She arranged summer work for me in a hematology lab, and when I returned to school in the fall, I got a job as a night hematology technician in the Baker Building at Massachusetts General Hospital (now Mass General Brigham, MGB). I would go to work at 5 p.m., eat dinner, work about 4 hours, do a little homework, and then go to sleep, finishing up at 7 a.m. I was available during the night if emergency blood work was needed. At that time, we did not wear gloves when we drew blood. When we did sedimentation rates, we sucked on a glass tube to bring the blood up from the collection tube, taking care so that we didn’t suck the blood into our mouths. I continued to work one or two nights a week at this job through the last three years of college and the first two years of medical school.
In my third year of medical school, I took night call in the hospital during some of my rotations. I remember one incident in particular. I was doing medicine at the Peter Bent Brigham Hospital, which became Brigham and Women’s Hospital and is now part of MGB. There were large wards with 16 beds. Each bed had only a curtain around it for privacy. One night, a man was admitted with acute pancreatitis. Among the treatments he was given was atropine to decrease his stomach secretions. Around 3 a.m., he started having hallucinations due to the atropine, so I was summoned from the on-call room to deal with the problem. The patient was a large man who towered over me and, given his agitated state, I was terrified. Still, I did my best to try and reason with him. While this encounter was taking place, all of the other patients on the ward were listening since the curtains surrounding the beds did nothing to stop the sound. Eventually, the effect of the atropine wore off and the patient calmed down. The fear I felt in that moment and the lack of control of the situation has made the experience stick in my memory all these years.
After medical school, I did a medical internship at Colorado General Hospital in Denver (now the UCHealth University of Colorado Hospital). This was a brand new hospital which, at six stories tall, was one of the highest buildings in Denver. The call rooms were on the west side of the hospital, and at 6 a.m. we could see the early morning sun shining on 100 miles of the snowcapped peaks of the Front Range of the Rocky Mountains. Even if I had been up much of the night, it gave me a real boost for the next day.
I then joined the Public Health Service to fulfill the two years of service required of all male physicians during the Vietnam War through the so-called “Doctor Draft.” I was assigned to Chinle, Arizona, a small town in the middle of the Navajo reservation. We had a small outpatient clinic, and the five doctors staffing it lived adjacent to the clinic and shared call, with each of us covering one night a week and every fifth weekend. Since most of the community didn’t have telephones at the time, we left our front porch light on and the sick person would knock on the door where there was a light on. I would then get out of bed, put on a bathrobe, answer the door, and tell the patient I would meet them at the clinic in a few minutes. Since there was no additional staff there, I had to do everything needed including blood draws, giving vaccines, and taking X-rays. For the first year, we didn’t have an automatic processor so we put the X-ray film in developing tanks. When the film was developed and dripping, I did a true “wet read.”
After Chinle, I returned to Boston for my medical residency at Beth Israel Hospital (now the Beth Israel Deaconess Medical Center). My wife had a job as a housemother at Simmons College. The dorm where we lived was right across the street from the hospital. That meant that when I was on call every second or third night, I could meet her and our two young children at the college dining hall for breakfast before returning to the hospital for morning rounds.
In 1972, I moved to New Hampshire to start practicing as a family physician with a group in Exeter, NH. At that time, in addition to covering outpatients and inpatients at night, all of the clinical staff had to cover the emergency room about once a month. It was challenging to deal with problems like major trauma, performing the initial evaluation and stabilizing patients while calling in surgeons. Fortunately, after 10 years or so, the hospital started an ER group and that part of call went away. In the late 1990s, the hospital started a hospitalist service. Initially, my group did not take part. Eventually, some members of my group started to push to have our practice use the hospitalist service. I initially resisted but eventually agreed to give up hospital practice. On my last night on hospital call, I had to go in and transfer a patient to Mass General Hospital. As I drove home at 5 a.m., I realized it was a good decision that we had made the transition.
Since that time, “call” has only been via telephone. Fortunately, I never had a problem falling back asleep, so, even on a night when I got several calls, I got enough sleep. My call became even easier in 2015 when I stopped my office practice and took call only one night a week and one weekend a month for the 200-bed nursing home that was my only clinical practice site. Many nights I got no calls, and it was uncommon to get more than one 3 to 4-minute call during the night.
Now, as of April 16, 2024, call has ended. That means, for the first time in 64 years, I will be able to go to sleep at night and not have to be concerned that I might be awakened by a call about a patient. That will be something I have not experienced since I was 18 years old. While being on call has given me many interesting and challenging experiences, it was time to take call for the last time.
About the author
*Feature photo obtained with a standard license on Shutterstock.
**Dr. Singer's headshot was photographed by his wife, Paula Singer, and can be viewed at the Singer Entrance of the Rockingham County Nursing and Rehabilitation Center.
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