Guest Editorial: Am I Too Old for the CICU Night Shift?
At 62 years and post-call from a sleepless night shift, I would say “absolutely not.” I stayed up with a neonate who was status post tracheoplasty a few weeks ago and yesterday underwent LPA sling repair, hilum-to-hilum pulmonary artery reconstruction, and truncus 1A repair. Am I tired? Yes! As Susan Nicolson, a cardiac anesthesiologist at the Children’s Hospital of Philadelphia and my mentor once told me, “Every day I go to work, I learn something new from my patients, their parents, or my colleagues.” That was exactly last night. The excitement of managing a constellation of lesions I have never seen before and sharing that enthusiasm with the night team of bedside nurses, frontline APNs, and fellows is energizing. There is a uniquely vitalizing and motivating experience managing the CICU at night. Late arriving post-operative patients can be marginal. Attention to detail is key to optimal outcomes. It’s an often-undistracted opportunity to focus on the subtleties of the exam and hemodynamics and share that perception with frontline providers and trainees. Signing off in the morning when you feel your years of experience (or old age) have made a difference not only to patients’ outcomes but also in a trainee’s understanding and enthusiasm is completely rewarding. Do I get tired at 3am? Absolutely. Do I wish I had cleared my calendar of meetings the following day? Absolutely. Do I drag on my runs for a few days? Absolutely.
What has changed? In 2007, I was doing 105-hour clinical weeks with every other night in the hospital, raising two young girls, and doing research on the side. That sounds impossible. In 2021, I do at most 80-hour clinical weeks. I made a commitment to myself to stop the day-night-day, 35-hour shifts. Although childcare in the traditional sense is in my past, my non-clinical obligations have grown astronomically.
Are there any external drivers to take call? Perhaps. Two highly-valued college tuitions were/are supported by the supplemental pay for call. And pre-COVID, I loved to travel. But in all honesty, I do not find the extra pay to be a significant driver.
Would I ask junior faculty to cover my call so I could opt out or reduce my load? Not yet. However, I have a much lower threshold now for asking if someone wants to pick up a call night or weekend. Supplemental call pay makes this enticing to others and reduces my guilt. While previously I only requested call coverage for work-related events, I now ask if there is an opportunity to get away with friends.
Our division chief at UCSF has initiated discussions regarding an age at which one can cut back or opt-out of call. I am completely supportive of colleagues cutting back or opting out of call at an older age (that age is likely individual and 60 seems quite reasonable). For now, I will continue to carry my share. I believe that when I find myself preferring the call room over being at the bedside managing the patients, that is when I should step back.
Sarah Tabbutt MD, PhD
Cardiology and Critical Care, Benioff Children’s Hospital
Professor of Pediatrics, University of California San Francisco
Executive Director, PC4
Director, Single Ventricle Home Monitoring Program
Physician Lead, BCH Heart Center Data Team
San Francisco, CA, USA