I am post-call and feeling funky, in the most unpleasant way. Taking 24 hour in-house call is like being an anesthesiology resident all over again: unpredictable emergencies of all kinds at any given hour are de rigueur, which combined with little or no sleep, create a Circadian biorhythmic hell. You get strange consults from the ICU at 3 a.m. that usually involve a request to place a central or arterial line in someone who is barely being kept alive on a ventilator with maximal hemodynamic support through a tiny peripheral IV, along with continuous dialysis. You are essentially being asked to go fishing for IV or arterial access on a dead person. Sometimes, the person actually has "do not resuscitate" orders on his or her chart, but these appear to be largely ignored in the quest for last ditch interventions.
I am perpetually amazed by the lengths physicians will go to sustain life, with a seemingly complete disregard for the quality of life (or lack thereof) that is to follow. As a physician, I have sworn to "do good" and "do no harm" to my patients: to me, this includes knowing when to stop! I am somewhat of an anomaly in the world of private practice anesthesiology because I value patient safety and advocacy at the expense of "cutting corners" to keep surgeons and interventionists cranking out elective cases so that hospital and insurance administrators can stay very, very rich. Why does there even have to be such a trade off? Until American healthcare becomes less focused on expensive damage control, and gets out of bed with the insurance industry, big pharma, and greedy corporations, physicians will continue to be pressured to "produce", instead of "prevent".