Sole Purpose 56
Being on Call

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This week’s article tackles what I initially considered the scariest part of starting residency: being on call. Now that I’ve made it through most of my intern year, I feel like I’ve finally got a handle on what’s expected—and how to navigate whatever chaos comes my way. But if you read my earlier piece about my first month of residency Sole Purpose 32 - The First Month of Residency, you already know it wasn’t always this way.

My first week on call felt like it was curated in the fiery depths of hell. This time I am not being dramatic. Imposter syndrome? Oh, it wasn’t just knocking—it practically set up shop in my brain and throat every time I answered a page as the so-called “Dr Santiago from podiatry.”

Some might label me a "black cloud," but I prefer to think of it as getting extra hands-on learning opportunities. (Glass half full, right?) One of my attendings even gave me a rather unique title: the “Queen of Blood and Pus.” I’d laugh, but after the fifth time in one night of changing my scrubs due to unexpected bodily fluids, I’ve come to embrace it. If nothing else, it’s memorable.

Today, I want to share how I overcame my call anxiety and a few tips and tricks that worked for me. Full disclosure: none of this is groundbreaking advice. In fact, most of it is just general wisdom I’ve picked up along the way in residency.

Call Schedule for My Program

Here’s how call works at my program, Ascension St. Vincent: we cover the main hospital at St. Vincent Indianapolis on 86th Street, with the occasional consult at a nearby sister hospital, Carmel St. Vincent. Call starts on Friday at 5 pm and lasts a full week, ending the following Friday at 5 pm. At first, the thought of being on call for seven straight days felt overwhelming—but now, I actually love the way our schedule works.

Back in my cross-country days, my mantra during races was simple: I can handle 10 more minutes of running. No matter how tired I was or how long the course seemed, I convinced myself I could push through just 10 more minutes of discomfort. (Side note: This mantra may not apply to my current hobby-jogger state, but the sentiment stands.)

When it comes to call, I take a similar approach: I can handle a week. No matter how little I sleep, how long the to-do list grows, or how chaotic things get, I know it’ll end by Friday. This mindset of “just one week” has been a game-changer for my attitude. It helps me stay grounded and reminds me that no matter what, I’ve got this. One foot in front of the other—literally and figuratively.

My First Call Week: The Breakdown

I’m a little embarrassed to admit that during my first hellish week on call, I did NOT have the “I can do anything” attitude I’ve since developed. By Monday, after barely sleeping all weekend and staring down a to-do list that seemed insurmountable, I felt like a complete failure.

Then, a kind second-year resident came in to say hi, drop off his backpack, and check in. That’s when it happened—I started crying. Right there. In front of my poor extern, who was assisting me. To make matters worse, this breakdown came on the heels of getting yelled at by an attending from another service. I was exhausted, overwhelmed, and utterly mortified to be crying in public.

After about 30 seconds of getting all my feelings out (OK, maybe closer to a minute), I pulled myself together enough to explain what was going on. My upper-level resident, to his credit, sat down with me, reviewed my list, and helped me make a game plan for the rest of the day.

At that point, it was only 10 am—and I’d already rounded on everyone. But I was stuck, unable to reach an attending for guidance. I didn’t want to make a move or book a surgery without permission. My upper resident reassured me that anyone would be struggling with a list like mine, especially given the complexity of my patients. He reminded me that it was literally my third day on call, nobody expected me to handle everything with perfect grace and poise. He also emphasized that call always feels overwhelming, even for more experienced residents.

Looking back, I’m still a little embarrassed about that emotional outburst. But I think it’s important to share just how low I felt in that moment. Knowing what to do on paper and doing it alone on call are two very different things. And while it was a rough start, that experience taught me that it’s okay to feel overwhelmed—and more importantly, it’s okay to ask for help.

Handling Stress and Rude Interactions

One thing I’ve learned is that other services being rude to me over the phone don’t really get to me anymore. A big part of this is how I’ve reframed the situation: we’re all probably tired, stressed, and maybe a little hangry. At the end of the day, the most important thing is that we’re all on the same team, working for the best outcome for the patient.

That said, I know I’m not at my finest when I’m on call. I can get short and more irritable than usual, so I make a conscious effort to stay respectful on the phone. After all, I’m not just representing myself, I’m representing my entire program and the podiatry profession.

Sure, I’ll vent to my co-residents if someone is especially rude or if I’ve been flooded with silly outpatient consults that don’t belong in the inpatient setting. But I do my best not to take my frustration out on the person consulting me. They’re just doing their job, too.

I also make it a point to introduce myself to doctors in person if I spot them roaming around. I’ve found that it’s much harder for someone to be rude to you after you’ve taken the time to shake their hand and say hello. A little human connection goes a long way—plus, it’s always nice to put a face to the name (or the pager number).

Don’t Fear Call: It Gets Better

I don’t want to scare any fourth-year students into thinking call is horrendous or that my program is out here torturing me into tears. The truth is everything gets better with time and patience. I survived that first week of call just fine, and I know I’ll make it through the rest of my call weeks during residency.

Now, I have confidence in myself. I know I have good bedside manners, I’m organized, and I get things done. I’m also realistic enough to accept help when it’s offered—whether it’s a co-resident asking if I need anything or a student grabbing supplies for me. Plus, I’ve developed a routine that keeps me grounded before and during call week.

Before call starts, I make sure to grocery shop and stock up on my favorite Trader Joe’s frozen foods. When I come home completely exhausted, nothing beats nuking some chicken dumplings in the microwave for two minutes. I also deep clean my apartment ahead of time because I know a cluttered space adds extra stress, and I won’t have the energy to tidy up once the week begins. To stay motivated, I always plan something enjoyable for when call ends—whether it’s a dinner out, a movie night, or a guilt-free nap.

Skipping meals on call isn’t an option for me (thanks, diabetes), so I’ve learned to prioritize having snacks on hand. Thankfully, I have the kindest co-residents, who always make sure our resident room snack drawer is stocked. The doctors’ lounges are also well-equipped with snacks that, so far, haven’t gotten old. These little gestures of support have fueled me through countless long days.

Call isn’t easy, but it’s manageable with the right mindset, preparation, and support. And yes, having a snack stash doesn’t hurt either.

Maintaining a Routine

I have a general routine that keeps me grounded during call. I start my day at the hospital by slowly sipping my to-go coffee and protein shake while reviewing patients’ charts. I print out the patient list and use my trusty multicolor pen to mark which patients need dressing changes and note which attending each patient belongs to. At the top of my paper, I write down any scheduled cases along with their assigned operating rooms. I also create a color-coded to-do list, prioritizing tasks by urgency.

Next, I check everyone’s labs to ensure there were no overnight changes, review any new notes from other services, and prep the buckets for rounds. I begin rounds on the top floor of the hospital and work my way down, ultimately returning to our resident room in the basement. My goal is usually to finish rounds and have all my notes completed before lunchtime.

At the end of the day, I follow a similar routine to ensure everything is in order. I review each patient to confirm their notes are completed and double-check that every task on my list is done. I make sure physical therapy weight-bearing orders are in place for all patients—easily my most frequent source of pages—and finalize discharge notes for anyone scheduled to leave the hospital. Before heading out, I check the ED board for any brewing podiatry consults. If I spot something, I use my solid relationship with the ED physician assistants to my advantage, shooting them a quick message to ask if they’re planning to consult me. It’s a small step that helps me stay ahead of the game.

Taking Time for Yourself

When I’m home during call, I try to live a somewhat “normal” life. I’ve learned that sitting at my dining room table, staring at my laptop with the ED board open and endlessly refreshing the page, only fuels my anxiety. Instead, I keep my phone on me with the volume turned all the way up and try to go about my usual activities.

I’ll often go to the gym or head out for a run, though I make sure not to stray more than two miles from my apartment so I can get back quickly if an emergent case comes in. I’ve found that getting outside or spending time at the gym significantly improves my mood compared to staying at home, paralyzed by the fear of missing a page. And trust me, it’ll be okay if you take a little time for yourself—I’ve answered plenty of mid-run pages or even mid-shower. You’ll figure it out.

Setting Boundaries

I get extremely sensitive to sounds when I’m on call. As much as I love my family, I have to put them all on “Do Not Disturb” during call. The constant text tones would drive me crazy, and the three-hour time difference between EDT and PDT has led to some late-night calls that wake me up in a panic, thinking it’s the hospital—only to realize it’s just my little brother telling me about the new shoes he bought. I make sure to tell my close friends and family when I’m on call, explaining that I’ll be less responsive. I put most of them on “Do Not Disturb” to cut down on the noise and gently remind them that I’ll return to reality in a week. If it’s an emergency, I ask them to call twice in a row to override the do-not-disturb setting, though a sale at Abercrombie is definitely not an emergency.

Get Sleep When You Can

Sleep is never a given during call, and I never know what’s going to come in or when. If I happen to get home early on a call day (meaning before 8 pm), I prioritize getting some exercise and then going to bed at a decent time (ideally before 11 pm). I’ve learned the hard way that staying up late to do unnecessary tasks leads to a miserable next day, especially if I get a 1 am nurse call followed by a 3 am consult. So, I don’t write articles when I’m on call (as tempting as it is)—that’s my favorite late-night activity, but not a priority at the time, nor is research. If I have a deadline during a call week, I don’t leave it to chance. I submit whatever it is before the deadline and plan ahead. That’s the only way I can guarantee I get everything done.

Plan Ahead

Planning ahead is key. I always keep a toiletry bag in my backpack in case I end up staying at the hospital. I know I’ll feel miserable if I don’t wash my face, brush my teeth, and change clothes. I made the mistake of not having a go-bag once, and one of my core attendings, Dr Winters, inspired me to be more prepared after telling me about his OR locker, which has everything you could possibly need to live in the hospital.

Conclusion: Embracing the Chaos

Being on call during residency can feel overwhelming, especially in the beginning, but it’s also where you’ll grow the most as a physician. The long hours, unpredictability, and difficult patients all combine to teach you resilience, time management, and teamwork. While it may never be easy, with time, you’ll find your rhythm. You’ll learn how to handle the stress, prioritize self-care, and navigate the challenges that come with it. Most importantly, you’ll realize that being on call is an opportunity to serve your patients, bond with your colleagues, and develop into the kind of doctor you’ve always aspired to be. So, take a deep breath, trust the process, and know that you’re more capable than you think. The end of each call week brings its own rewards, just one week at a time.