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Tips to Keep Going: Surviving 24+ Hour Shifts in Med School and Beyond

My first 24+ hour call as a medical student was one to remember. I was on my Ob/Gyn rotation, and the night was buzzing with activity: two emergency C-sections — one for placental abruption after a mother used cocaine and another for a women with active primary HSV infection — as well as nearly half a dozen deliveries on the floor. Needless to say, it was a sleepless call day. By the time I hit my 28th hour that morning, I remember being so weak that I was literally clenching onto a countertop to keep up right.

Now as a resident, I’ve adapted some tips and tricks for better managing these long calls. Here are my top five recommendations for surviving 24+ hour call:

1. Come prepared.

It can be surprising how busy a 24+ hour call can be. I have made the mistake of not bringing enough food/snacks/drinks with me. During a particularly busy shift, it is entirely possible that you may not have time to run to the cafeteria for a quick bite to eat. Therefore, it is imperative that you bring enough food and snacks with you so that you can eat on the go, if necessary. I often kept 1-2 granola bars in my pocket so that I could eat between calls or when walking between rooms.

For most people, it won’t be possible to stay awake, alert, and focused for an entire 24+ hour call shift without some form of caffeine. I would often bring hot tea bags, energy bars, soda, or other energy drinks with me to use as needed. Therefore, when 3 am strikes, if my second wind died, I could have a little extra energy to make it through those final hours.

2. Sleep when (if) you can.

At least in my experience, as a medical student and intern, sleeping during a 24+ hour shift is highly unlikely. When on first call for a service, it’s often too busy to sleep. That being said, if you ever experience downtime, try to catch some shut-eye when you can. Most institutions have call rooms for residents (and sometimes medical students) to use when able. It is surprising the difference a 20-30 minute nap can make at 3am.

3. Take breaks

If you find yourself overwhelmed and exhausted during a long call, try to take a short break here and there. Even if it’s just a few minutes to reset and recenter yourself: walk to the bathroom, take the stairs instead of the elevator, grab a snack. Squeezing in these little breaks during a long call shift can really make a difference in helping you keep focused and energized.

4. Recover well post call.

Due to the pure exhaustion that comes with being on your feet and staying alert and focused for 24+ hours, most people have no trouble sleeping after being on call for that long. However, it’s important to remember to take care of your mind and body in other ways too. In addition to catching up on sleep, try to get in a good meal after a long call shift. It can be difficult to eat healthy, balanced meals while on long call. In my experience,my on call diet consisted mainly of multiple granola bars, crackers, soda, and energy drinks. On post call days, try to eat healthier, well balanced meals, and if time permits, try to squeeze in some physical activity. Proper nutrition and exercise will help you feel more refreshed and capable of tackling your next long call!

5. Know when to ask for help

24+ hour call, especially as a medical student and intern, can be very daunting, exhausting, and mentally taxing. If things become overwhelming with a patient who is crashing, unstable, has out of control blood pressure, etc., it is okay (and encouraged) to ask for help. Especially in medical school and early in residency — when you’re still learning the ropes and you’re not expected to know everything — there will always be someone you can turn to when on call. Don’t be too afraid or too prideful to contact a co-resident, junior, senior, or even an attending if a situation seems like it could be difficult to handle alone.

While 24+ hour call as a medical student and resident can be daunting, at the end of the day, challenges like these push us to become the best physicians that we can be. Whether these shifts are a permanent facet of your specialty or a temporary part of your career during your time as a resident physician, I hope these tips will help you survive your first long call.

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