It's Thursday night and I have a sick feeling in my stomach. The reason is that tonight is the first night of my two weeks as the neurologist on call.

It's a feeling I've had many times before as I approach my first full year as an attending neurologist but I still haven't gotten used to it. As a resident I had to do many calls. They were the grueling overnight stays at the hospital at the beck and call of the high pitched beeping of my pager. Most of the time, it would be for minor reasons like giving a sleeping pill to an insomniac patient or some Tylenol for a headache. Even if it were something serious like patient rolling into the ER with a fresh stroke or uncontrollable seizures, while it would get my adrenaline going, I always had the comfort that I could call my attending for help. Also as soon as my call was over, I was off the clock, my responsibilities over and I could go home and sleep easy.

As an attending, it's a far different feeling. The pager only goes off when something major is going down and the resident needs my help. I'm the one that's supposed to have all the answers and know what to do in every situation. While I have this board certificate hanging on my wall that supposedly proves I have met the requirements to be a "competent" neurologist, I always have the lingering fear that I won't know what to do or even worse, thinking I'm doing the right thing when instead I've made the wrong decision. I second guess myself all the time, ruminating over every patient decision making sure I didn't miss anything (and probably driving my residents crazy in the process). I don't sleep quite as well because of the uncertainty that the pager could go off at any time. It's also a two week stretch so always being a little on edge for that time really wears on me. I once asked one of my senior colleagues who has 20 years of experience if this feeling ever goes away and he simply replied "only when you retire."

Well here's to another two weeks of call. Pass the Pepto-Bismol, please.