“I hate to call you but we have ten pending”.

Back up lovers, anyone? None? I knew it.

Back up shift is a regularly scheduled shift of my hospitalist schedule. It’s when someone is sick and can’t come to work, or has a sick kiddo, or when they totally ignore their schedule and go to Hawaii for the weekend (People who are thinking how that’s possible. It is. Anything is possible with the vacation aspirations/inspirations we have and the urges we get).

Back up is a strange shift, to put it mildly. It is a day or night when you could potentially be called in because that guy hasn’t come back from Hawaii because he didn’t count on the flight being seventeen hours back home ( don’t ask me why he didn’t think the flight in is just as many hours usually as the flight out. People forget these insignificant details in Hawaii) or because someone suspects for the fourth time that they’ve got flu in May (they did see a kidney transplant with flu last week. Granted this doctor isn’t on immunosuppressants and the patient’s flu test was negative, but his clinical judgement has to count for something) or because someone’s wife isn’t going to let them go “hang out” at the hospital because they didn’t do laundry this week so now they have to save their marriage (physician marriages are egalitarian enough already. Laundry is the last thing we need to complicate things).

Getting called in is actually the easier part. Hospital is such a familiar term and place to me that being called in is like how I used to get called into the principal’s office. That office had more familiarity than my home room as I spent so much time there. The home room was a strange place with a woman who called herself my teacher. In reality, the secretary in the principal’s office taught me all I know about life, like blowing my nose right and doodling on paper during boring classes. She also told me all I needed to know about men so if school is for formative experiences, I lived all formative experiences vicariously through her during my long waits for the principal, who might I complain, had no regard whatsoever for my time. I’m not really complaining. Spending enough time in that office ensured that I heard the dirt on most of my classmates. I never shared this knowledge with anyone. I didn’t want any more candidates for the office. That could risk me losing my vantage point.

Coming back to our back up policy! So like I was saying, getting called in is easier. First, like I mentioned, complain as I might about how much I work, hospital has become a haven of sorts. I mean, I get catered more at the hospital than at home. Or even at a restaurant. The cafeteria gives me food, the nurses share their treats with me, the patients love me. That isn’t the type of life I enjoy at home most of the time. At home, I’m responsible for my own food (even though I’ve offered to pay my husband for making it), my kids have never shared anything with the word “candy” on it with me. Whether my family loves me or not is debatable. They’re very temperamental.

But what happens , in the rare event, when you aren’t called in right when your back up shift starts. I’m a nocturnist so my back up is 9PM to 7AM. Now, I’m not sure if it is just another way that God intends for me to pay for my sins but back up night is my “I start yawning and craving for my bed at 7PM” night. This night is especially generous in how it brings sleep for me. Also, every back up night, one of my favorite shows is on TV. Invariably, every back up night my kids want to cuddle and my husband wants to love me. See the conundrum here? See how adulting is making me choose between family and work? This stuff isn’t easy.

Since my family goes to bed at 9PM, I go to bed with them. But I can’t sleep. I’m afraid that the phone will ring as soon as Justin Trudeau and I are sitting down for a coffee in my dream. I’m afraid to move from my bed because I worry that nature might take this as an indication of being ready to go to work and will actually have someone call me. Even though I don’t move from my bed, I don’t lie down either , because in my past experiences with Luck, she likes to bate me. And as soon as I lie down, one or the other of my partners who are working at the hospital and waiting for a chance to call me in to join them in their work, call me. So I don’t lie down completely. I try to trick Luck by sitting upright with my eyes closed. This way I’m uncomfortable enough for Luck to be happy with how she’s screwing me.

But I can’t sit upright for too long. This hasn’t got anything to do with my bones or some back condition that you were going to diagnose. No! Sitting upright actually makes me question my existence . It makes me realize that all these minutes that I’m waiting for that call, I could spend doing something productive and worth staying up for. So I quietly tip-toe out of my room, go down the stairs, there’s our Peloton bike right there, I walk past it and reach for the pantry. I look for any junk food that we might have. I rummage around in the pantry and land on some saltwater taffy that I got a year ago and didn’t like the texture of. But that’s all I’ve got so that’s all I’ll have to eat. I next plonk myself on the couch, and turn on the TV to watch, The Real Housewives.

Which one, you ask? Hmm. That’s an interesting question. I’m always happy when people take an interest in something that others would pass off as a mundane detail. I’ll preface this account of the Housewives franchise by saying that my husband is too frugal to ever upgrade our Hulu subscription so we don’t have the Dallas Housewives. You can imagine my grief about that. They’re rumored to be pretty good too.

Depending on what my mood is, I make an educated choice about the city I’m gonna watch that night.

If I want hilarious fights over who has more money then I tune into Atlanta.

If I want cat fights with Bethany Frankel wanting to polish her future career alongside Kathy Griffin as a stand up comedian, I watch New York.

If I want to know about an obscure land, that I had never heard about before six or seven housewives sprang out of it, but is actually one of the most affluent communities in our country, I watch Potomac.

If it’s going to be middle-aged women with reality TV husbands, it’s going to be Orange County.

If I want richer than rich women, who own many other reality TV shows, I watch Beverly Hills.

If I want to see women with no regard for being filmed, I watch Miami.

But if I want mindless entertainment and that’s all I want for that night, you can count on it that I’ll watch New Jersey.

So this whole process of what to watch should’ve lasted longer than this but it doesn’t because our Hulu subscription has expired. I know you think that I’d be disappointed but actually this is a good thing. Let me explain.

By luring me out of bed, making me rummage through the pantry and land on a questionable food choice, having me turn on the TV only to find my Hulu has expired, Luck is trying to make me guess what’s gonna happen tonight. And I think I’m guessing it right. “I’m gonna be miserable tonight because I’m not gonna be able to watch or eat anything of my choice tonight”. Others would be disappointed but the way my luck works, this is absolutely heartening. More than ever I know that the provisions of my misery have been made available to me right here at home and therefore I won’t be getting called in tonight.

This is rejuvenating. This type of calculation has proved to be quite fool-proof in the past so I casually throw the bag of taffy down and instead decide to do something more meaningful. Yes you got it! I decide to engage in an advice-giving social service on a online woman’s only forum and make an opinion or two about women who have so much free time that they get involved in others’ problems. I’m above this. I’m just waiting for the back up call to come. (But I secretly know it’s not gonna).

I can’t do this all my life. I mean these women have endless problems and loads of time so I have to find something else to do with my time. I look at the clock. Why! It’s only ten o’clock yet. The way this night was whizzing by you would’ve thought it was already 7 in the morning.

This is crunch time at the hospital. The swing shift is on for another two hours but those guys, I know, are already checking out mentally. They’re laughing to themselves as they watch the list of patients to be seen getting longer. They recommend to the night team if back up should be “activated”. Yes this is how they talk about me. Like I’m an inanimate object. Or like if they activated me I’ll see twenty patients in one night and no one will have to work. But the terminologies in hospital medicine are my least concern. I’m just worried that since I’ve been becoming comfortable staying in tonight, I am running the risk of being called in more than before.

But I don’t let Luck sense my nervousness. I act confident but not so much. I’ve known for a long time that she has a problem with my cockiness and so I act to her as subjugated as I can. Call me a sucker but I can’t have my entire life studded with embarrassing moments just because I tempted her.

I deliberately don’t look at the clock. This has never worked for me. Time, my friends, is never on a woman’s side. I surreptitiously glance at the clock but I never make direct eye contact with it. Nope! The clock actually gets offended a lot with my direct gaze. It starts to run faster or slower depending on how I don’t want it to run.

So now it’s 10:30 PM. If I haven’t been called in yet, chances are that I’m safe. But now I’ve been up with so much trepidation and anxiety that I can’t unwind. I curse the people in the ivory tower for not paying my Hulu bill and losing the subscription (my husband sits in the ivory tower at our house. Don’t take my mother-in-law’s words seriously when she says I wear the pants in this relationship. My husband and I both wear pants but because my mother-in-law was heavily influenced by military law in Pakistan, she likes to create a hierarchy and power play everywhere around her. Needless to say I’m her least favorite person in the world just because I’ve never sucked up to her. In my defense, I would’ve but since I’ve met her I’ve been very busy).

I go back to my general musings about my life and its operations. My nephew’s wedding is coming up. He’s my husband’s nephew actually but we are close so I’m really looking forward to his wedding. That and also, Toronto is a nice place because of all the food options. This is my message for all halal keeping Pakistanis. Toronto has the best food. I know you’re satisfied with the substandard food in Chicago and Houston and Dallas but really! Toronto beats them all. Toronto actually may have beaten Karachi.

While I’m picturing myself enjoying delicious food, one amazing restaurant after another, for a while I’m transported to a time of causal adulting. When I had no real responsibilities but was respected like an adult. Married folks know this phase well. The rest of the world calls it the “honeymoon”. I call it “spending your husband’s dime and being okay with just being pretty”.

As I’m sitting there with my mouth deliberately not forming a smile because these “smiling to my self” moments are almost always caught on our nanny cam and make for a good reason why my husband doesn’t accept me as an adult, I’m also aware of what I’m avoiding to think about. Yup! Back up!

I take another quick look at the clock in my sneaky, nonchalant way. It’s almost midnight now. This is looking good. I may not get called in after all.

Midnight is a unique time in a nocturnist’s life. It marks the beginning of almost half the shift. It also marks a new day. It is when we can sometimes see the ED slowing down completely. It is sometimes when major trauma comes in. Midnight is a representative of change most of all. This usually determines which way the night is going to go.

Slowly the clock inches forward and I’m reminded of ice cream in the fridge. Why didn’t I think about that sooner? I jump up, dash across the living room and open the fridge.

Now, let’s take a break here so you don’t become judgmental of my ice cream eating habits.

Ice cream, as the name implies, is a food with an undecided texture and place in the pyramid of food. It’s not solid but it’s not liquid. Now an alien might ask “so is it gas?”. You can derisively laugh now at how stupid aliens are. I mean they purportedly wanna take over the earth but the amount of information that they actually have about us is just not enough. They don’t know that humans have actually evolved so much that we are not restricted by the three states of matter anymore. We have actually created a fourth state of matter like ice cream, a fifth like taffy and a sixth like Pakistani food.

Because ice cream is a different state of matter, I eat it like a different state of matter. Women know what I’m talking about. I eat it with a large spoon, out of the tub, sitting on the kitchen floor, close to the freezer. You have to maintain that proximity to the freezer in case one of your kids snuck up on you and you’d have to dive forward to deposit the tub back in the freezer. This is important so they don’t learn this way of eating ice cream. That would be gross.

I gently take the ice cream out. I treat it with the utmost respect. Some historians in coming years might compare my respect for ice cream with how some people respect investment bankers. Ice cream is so high on the food chain of food that it could practically make all other foods go in oblivion if it wanted. It could make itself the sole food for the entire mankind if it wanted to. But decent food as it is, it has never tried to flex its proverbial muscle to exercise that type of power and control.

I open the tub of ice cream. I can see that my husband has been careful in following my choices. He unfortunately insists on getting low-calorie ice cream which is truly stupid because I eat enough of this low calorie type to gain a few pounds regularly. Bless him! He’s a dear dear man who is not giving up on me despite my history of inflexibility.

I again steal a glance at the clock. It’s one in the morning. I immediately regret my decision to eat ice cream. Luck knows I’m enjoying myself. I’m tempting her. This isn’t gonna go well. I shouldn’t have done this. I’m willing to sit here the whole night with the tub in my hands, my spoon carefully raised in the air, if that’s what would make Luck happy. I’ll be miserable. That’s what she would like.

But then it happens. I had been keeping it quiet the whole time but this little person in me, who has way more courage to stand up to Luck, starts to shame me.

“So is that how you’re going to spend your life? Not eating ice cream just because you might get called in”?

“You don’t get it. I can’t tempt her. It never works for me”.

“So screw her! You’re pathetic”.

Emboldened by my alter ego, I finally heap a spoonful of the ice cream and start to savor the moment. As the spoon gets closer to my mouth, I can hear a quiet angry huffing from Luck. I’m frightened and liberated at the same time. I’ve defied her power and hold over me. She doesn’t control me anymore. All these preemptive strategies that I employ to avoid being called in for back up, I never had to. This was all in my head. I was just playing by a program that she had set for me. She’s just as weak as I am. As I’m celebrating my emancipation from my tormentor, the spoon just an inch away from my mouth, I hear a loud ring on my phone.

My heart thudding in my chest, my hand with the spoon limp, the faults and sins of my entire life rushing before my eyes, my bed calling me with love and warmth, the walls closing in on me, my Luck suddenly contrite at being so messy with me, I pick up the phone.

“Hey! What’s up?”

“Sorry Sonia! I hate to call you but we have ten pending”.

“I’ll be there”.

I get up, change and sit in my car. I realize this is familiar. I realize I’m going to a familiar place. The familiarity of this routine takes over immediately. It’s like coming home…… in a physician way. In a way that a physician holds the hospital close to heart. In a way that we become a part of the hospital and our patients as soon as we start off to go to work. In that moment, back up becomes another shift, that I had known about all along.

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