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Now that I am halfway through my first year of neurology residency, I find one particular facet of training that I have still not come to terms with – call nights. During the days, the sun outside must make neurology seem brighter and clearer. Spending the days engrossed in work, learning about disease mechanisms and interacting with my peers, I find myself tired, but calm. At night, alone in the hospital, I find myself exhausted and stressed. I am actually surprised that after almost two years of taking call, I still have a negative feeling about call nights. In my mind, this is what differentiates residency from most professions.

Days before a call begins, I start packing my overnight bag with my “lucky” shirt, stuffing the pockets with books I won't have time to read and always adding a dash of dread as filler. I have heard of residents pumping themselves up with caffeine, but I just fill myself up with fear.


I wonder if it is the uncertainty of what a call night might entail – the quiet solitude or the busy confinement. Is it that I am still not certain if I know what I'm doing? Or is it the ever-daunting task of the physical, mental, and emotional drain of life as a resident? I have to ask myself if these fears are unfounded or if they are unique to me, my field or to the overall practice of medicine.

I recognize the numbers now. I've learned to relax when it's 5350, the ward nurses; stiffen when it's 5336, the neuro-ICU; and cringe when it's 9595, the University ER.


I find myself engaging in a dance of relaxing, stiffening and cringing when I see that all three are trying to reach me at once. When I conclude that the stroke patient is clinically stable, I chance a mad dash to the nearest phone. On the way, I run into an ER resident, clipboard in hand, ready to rattle off a new consult for me. I jot down some quick notes on her case and find myself thereafter continuously being accosted by residents with new consults.

I do not know how to describe the feelings that overcome me on nights like these. I think it is just the stress coupled with the lack of food, water, and sleep that make me feel our jobs as physicians-in-training are unique. The sheer amount of work, intermixed with the fear of the unknown and the mental strain involved in trying to recognize syndromes and symptoms at 3 a.m., is a battle unique to being a resident physician.


In some cases, the tale is simple – a neurological exam with right hemi-paresis, left gaze preference and an aphasia quickly implies there is a left middle cerebral artery infarction and one can determine the events that will follow. In others, the relationship between encephalitis, the fleeting whole body rash, and the bite of an unknown creature are so complex that the story cannot easily be predicted.

I have recognized that call nights are not for curing patients, but rather for recognizing important signs and stabilizing patients until more experienced hands can help you sort things out. Often, the only flower in the bed of thorns in a call night is the looming eighth hour of the morning, with its freedom from the clutches of my pager and the swarm of residents and attending physicians that it will bring.

Things always look brighter in the morning when I have my warm cup of hospital coffee in hand. On the flip side, I know I should consider what my patients are going through and realize how much a neurologist is needed in the hospital at night.


To us, it is another consult, another page, but to the patients – it is part of the story of their lives. How good health escaped them and viruses or tumors or blood clots devastated them. How an ordinary day turned into an extraordinary day when their right arm stopped working as it should or the crystal clear vision they took for granted all those years turned double. These are their stories, each as unique as the strength of their grip, the creases in their smiles, and the movement of their toes.

And my story? Serializing life as a resident isn't easy, but residency, like a call night, is also finite. It is likely that my call nights will not only be my strongest memories of training, but will serve as the foundation for my career as a neurologist. The mistakes I made I will strive to remember next time. What I did right, I will be silently thankful for. Whether or not my lucky shirt will still be lucky two years from now – now that remains to be seen.