Ports of Calls: toward a taxonomy of hospital on-call rooms

Mike Wong
Halifax, Nova Scotia, Canada

 

Clinical clerks’ on-call room.
Photographed by the author. 2018.

Glancing around the dimly lit 10’ x 10’ chamber, I placed my backpack on a wilting twin mattress enveloped in standard issue, blue striped flannel sheets neatly folded into hospital corners. Between the doorframe and water-stained ceiling, with indifference, flakes of glossy white paint continued a months-long endeavor to divorce themselves from an otherwise unadorned cinderblock wall. Meanwhile, under a coarse veneer of dust, its garish palette only slightly diminished by the passage of years, an entirely forgettable Thomas Kinkade rendering of some imaginary woodland hovel rested on cold linoleum, yearning to be hung up and displayed. As with its neighbor, a rotating desk fan steadfastly refusing to turn on, that article of kitsch sadly never enflamed anyone’s passions sufficiently to conjure up the requisite work orders that would fulfill its dreams of functionality. Equally forlorn, a coffee-stained 2003 edition of CPS [Compendium of Pharmaceuticals and Specialties] rested wearily on a miniscule, pock-marked, and graffiti-laden writing desk.

At the time, I was a newly-minted clinical clerk starting on a busy Internal Medicine inpatient service. The night would of course bring new admissions to be seen, a litany of minor fires to be extinguished, and the lingering possibility of a Code Blue or another disaster. As expected, not until the wee hours of the morning would I shamble back to this room that offered only slightly less visual stimulation than a blank sheet of white cardstock. Though exhausted, my mind thundered through the night with nervous energy, guaranteeing no slumber before I would next be incited to action by the pager’s din. Yet despite this irresistible sleeplessness, I found the mere sensation of briefly sinking into the bed’s cool embrace was enough to transfigure the on-call room from an ersatz prison cell to a sort of private oasis.

With the passage of subsequent weeks and additional nights on the wards, I returned again to seek safe harbor in the same on-call room. During these nights, I came to become more comfortable with caring for my patients, as I worked to gradually develop the knowledge, wisdom, and confidence that I would need in my future life as a physician. That room, unimaginably bland and nondescript as it was, inevitably and irreversibly bound itself to my memory.

As the first on-call room in my clinical life it proved to be an effective archetype. I would encounter many others like it, on other specialty services, in different institutions, in far-flung cities and even on other continents. Regardless of the setting, these rooms were remarkably similar variations on a very simple theme. Their monotone décor would be characterized by the same fundamental repeating elements: a bed, desk, phone, and an intangible quiet resignation to existence as an after-thought. On some particularly brutal and punishing rotations, on-call rooms (even bunk-beds!) shared with others on duty ensured that each pager’s calls would maximally disrupt their futile attempts at a restorative slumber. In contrast, on some lucky services, these oft-neglected temporary dwellings would be blessed by a kindly administrator with some additional features, like a computer to follow up on patient investigations, an ensuite bathroom, or perhaps even a small television to help whittle away sleepless hours.

I always appreciated efforts to decorate these places, and impress on them some slight manner of personality. During difficult nights, I felt the consolation that can only be expressed in the form of faded motivational posters from the 1990s. Seeing framed photos of residents from days gone by, I wondered about the other lived experiences of those who came before me, who spent countless prior nights on duty in the same room; I realized early on that the overnight SOAP note never quite manages to convey the same strong emotions borne during the night time.

There were often small glimpses of whimsy in these places, as well. For instance, one could spend hours trying to decipher inside jokes scrawled onto on-call room whiteboards, a task as difficult as interpreting scribbled notes on those inevitably misplaced overnight patient census lists that always turned up in the room weeks later. And it always conjured a smile to my face to behold, displayed on an on-call room wall, a poster bearing an aspirationally idyllic scene, standing in as an imitation window. On truly lucky occasions, some on-call rooms even boasted real windows through which one could gaze longingly at the daylight’s diminishment into dusk, before awaiting the sun’s return to mark the night’s voyage complete.

Specifics aside, all variations on a very simple theme.

In this simplicity, an implicit sense of community.

The shared experience of attempting to sleep in these little rooms, while wielding a capricious pager, provides a common frame of reference for physicians around the world, automatically invoking a sense of comradery and understanding. Not to be forgotten, and also familiar with this setting, are myriad nurses, technologists, and other ancillary staff, all working toward the same end of standing guard against misery and death in the night. For me, there were many long nights on duty that never seemed to end, but they each granted me the privilege of honing my practice of medicine, ultimately allowing me to become a better physician in the service of my patients.

And so, the drab and unremarkable nature of the on-call room is really no problem at all. While on duty, it is simply reassuring to know there is a port in the storm. A place to temporarily escape the horrors or minor annoyances of the night time. A place to take refuge in calm waters, in a quiet harbor. A place to weather the storm and emerge, in the dawn’s early glow, stronger and better than ever before.

 


 

MIKE WONG is a final-year anesthesiology resident at Dalhousie University in Halifax, Nova Scotia, where he also attended medical school. Informed by his undergraduate background in neuroscience, a brief period as a psychiatry resident, as well as his specialty training in anesthesia, he is fascinated by the interdisciplinary practice of pain medicine. He is writing a book on the history of hospitals in Atlantic Canada, and curates the @portsofcalls Instagram/Twitter feed, collecting photos of hospital on-call rooms from around the world.

 

Highlighted in Frontispiece Volume 11, Issue 3 – Summer 2019

Spring 2019  |  Hektorama  |  Education