High On The List Of Conversations Not To Have When You're Post Call Is...

...a discussion of the differential diagnosis for elevated liver enzymes.

Let's back up, shall we!

Post call is the day/ medical-legal term/ state of consciousness that occurs after an overnight shift at the hospital. "Call" has varied meanings in different health systems. For medicine residents, it usually means:

• Coming to work at the normal time of 6:00.
• Working all day.
• Taking care of the hospital service patients at night.
  
• Staying at the hospital overnight to admit new patients.
• Sleeping from 0-4 hours in a special call sleep room.
• Being available to answer pages from the floor or the ER and responding to codes, if needed.
  
• Presenting the patients (new and old) the next morning to the regular day team.
• Leaving the hospital no later than 30 hours after arriving.

In Spokane, things are a little different. They run the residency program like a hospitalist service. This means that one team of residents signs in at 6 AM and they hand off their patients to the night team at 6 PM. This is what is called (pejoratively by some) shift work. These transfers are called sign-outs. While the residents work 12 hour shifts, medical students in Spokane take the more standard 30 hour shift. But we are not limited to 30 hours. No legal recourse exists if we work more than 30 hours in a row or more than 80 hours in a week. That protection only applies to residents. Something to look forward to, I guess.

Well, tonight was my very first overnight call. My two previous rotations set medical student call as morning sign-out until midnight. Since my current hospital has a call room for medical students, I get to stay all night. I admitted one patient, and then checked up on my other three, one of whom had a new finding of elevated liver enzymes. Which brings us to the original point of this post: It is difficult to access information (even the basic stuff) when you are not used to staying up all night. There are a number of reasons liver enzymes could be elevated. And because I'm a nice guy, I'll tell you what they are.

• Drug Toxicity
• Acute Viral Hepatitis
• Steatohepatitis (Alcoholic and Non Alcoholic)
• Biliary Obstruction
• Infarcted Liver
• Traumatic Injury
  

Actually I made this list in a (probably futile) effort to cement them into my drowsy brain. But there you go. Good night Irene, good night Irene...