Sunday, March 27, 2011

Pager Anxiety*

I was on call for 7 days starting last Friday. My mother watched Babyboy all day until I got home from work close to 7 pm. My husband was traveling. Mom and I had a bowl of soup together, and then she went home. I was thankful knowing she would be on duty for me Saturday and Sunday so I could go in and round on my patients. Babyboy and I set about our usual Friday night routine: he sat on my bed supported by pillows as I got my pajamas on; then we did tummy-time for a bit and sang songs for a bit. As soon as he started to rub his eyes, I darkened his lights, set Sleep Sheep on “rainfall”, and gave him a warm milkie bottle. And as per usual, he conked out.
Time for Mommy to conk out. I set my pager on the bedside table, turned out the light, and nestled down for the night. Then, “Bip!” the pager went off. I startled and turned the lights back on and fussed with my glasses and looked at the page text: an urgent page from someone with a sore throat. Sigh. I got up, logged into the computer, pulled up the patient’s chart and called her. A young new mom, her baby is in daycare and is on his 3rd course of antibiotics for an ear infection. Now she’s had a very sore throat and fever over 101 and difficulty swallowing. She knows she should have come into the office, but between work and the baby, she couldn’t. She’s miserable, she’s pretty sure this is Strep, can I help her? Sure. We chatted, she was very gracious, and I felt good to be able to help her out. I called in her Amoxicillin and that was that.
I again set the pager down on the bedside table, turned out the light, and settled down to try to sleep. But how could I sleep when I kept worrying and fretting that the pager would go off again?
Sigh. This has been an ongoing issue since residency. As a resident, when you’re on call, you’re in the hospital, often covering more than one service. As an example, when I was on Pediatrics call, I sometimes would cover two floors: toddler and school age. Back then, each floor had their own pager. Then there was the clinic pager. This in addition to my own personal pager. So it was not abnormal to be wearing 4 pagers. I had to double-knot my scrub bottoms so they stayed up with all these pagers clipped to my waist. It was a feat to use the bathroom and not lose one down the toilet!
And they beeped. A lot. I remember being on call one overnight at a satellite hospital. I was the resident covering the Peds ward, admissions, and backup for labor and delivery. I was paired with an intern who was thankfully a smart and cool-headed guy. For most of the night, we were working with a newly admitted teenager in diabetic ketoacidosis. The teen was on an insulin drip, and their blood sugars, electrolytes and acid/base balance had to be watched carefully. We were being paged so often about the teen that we decided to just stay up there. But, BEEP! A code in the ER! An 8 year old in status epilepticus. We ran and got there at the same time as the on-call anesthesiologist. We decided to sedate and intubate the boy, give as much Valium and other antiepileptics as we could and call for transport to the Main hospital. Then, BEEP! we were STAT paged to a delivery. The resident covering Neonatal was already in a delivery, and there was another imminent delivery that required Peds presence: premature TWINS. They were 32 weeks, which is little but not too too little. They would need to be in the NICU (Neonatal intensive care) for a few weeks, but they were fine. The whole time there were numerous other pages: issues with the admitted children on the ward, beep beep beep; some new admissions to go and see, beep beep. We split up to try to cover it all.
That was a pretty bad night on pediatrics, but it wasn’t abnormal. Medicine codes were much more common, and arguably worse, because people died more often. The medicine code pager, which went off if there was an adult in cardiac or respiratory arrest somewhere in the hospital, had the loudest, most obnoxious sound: “REE-OO-REE-OO-REEEEE”. If I’m in my hospital now, and someone’s pager is set to that tone, I get so uncomfortable. I want to run, or hit them.
I now have my pager set to a sound that isn’t at all like the ones I had in residency. It’s a little “Bip!”, almost a chirp, really. And it never means I have to run anywhere. I only need to be able to pick up the phone and talk, and think. But when that thing goes off, I might as well be back on the floors again. I’m like a returned soldier from ‘Nam, man. Just a tad PTSD.
There was even one holiday weekend, a Fourth of July, where my office was closed on a Friday. I was on call starting that morning. It was a beautiful day, sunny and warm. But the pager went off every five minutes for the whole day. I was planted at my desk, fielding calls, reading charts, looking up answers, trying to keep track of all the issues. The calls piled up. People were annoyed that the office was closed, and that I took so long to get back to them. I went into a full-fledged panic attack at one point. I can now tell my patients with panic attacks that I really do know what a panic attack feels like.
And so, a week ago Friday, there I was, in bed and trying to sleep, in the safety and comfort of my own bedroom, and I couldn’t sleep, after just one benign page. I even started drifting off to sleep, and hallucinated that the pager beeped. I woke up and turned the lights on and stared, but there was no blinking callback number, no message.
I finally fell asleep. Then, at 4:30 a.m., “Bip!” From the deepest sleep, I startled, turned the light on, fumbled with my glasses, and looked at the message. An urgent call for nausea, vomiting. I sighed, pulled myself up and to the computer, and dialed. The lady had school-aged children. She couldn’t keep anything down. I talked to her husband. We agreed that he would take her into the emergency room. I called the emergency room to let them know she was on her way and that I suspected Norovirus, that she would likely need IV fluids. I typed a brief note. I went back to bed.
Two hours later, I was still awake.
*originally posted at March 19, 2011


  1. Home call is the worst when there's a good chance of getting called in. There was a hospital I took call in during residency where I ended up having to drive to the hospital in the middle of the night probably 70% of the time. Between home call and worrying about the baby waking up during the night, I developed sleep dysfunction by the end of my residency.

  2. I know. I still get SVT sometimes when the pager goes off, and it's been almost 30 years.

  3. I would like to leave a thoughtful, insightful comment - but I'm too zonked from having been on home call and taking so long to get back to sleep after the few pages I got that I just can't.

    I do agree - home call where you have a reasonable shot at being called in or of staying home is the worst for this. After a couple weeks of this recently, even my toddler daughter began yo get upset and stressed when she saw the pager go on.

  4. I'm just a premed, but I have who is somewhat medically needy. I know the difficulty of falling asleep when I'm "on-call" when she gets sick and the frustration of waking right back up after I've fought my way back to sleep. Can't wait for residency when I get to deal with that x 10! ;)

  5. Hah! I loved your comment about PTSD...even as a senior fellow who doesn't have to hold the pager that often, it still gives me extreme stress. As in, it's hard for me to go out and have a nice dinner, for example, and really enjoy it, etc. I'm impressed the chirp wakes you up though - I have to have the loudest, most annoying sound on mostly out of paranoia that I won't hear it.

  6. And even when you are asleep, you're not getting good sleep.

    When I am back up call (my call is in house) and my husband is out of town, my dilemma is: do I keep the nanny overnight just in case? I only get paid if I get called in and I rarely get called in, so it's an expensive /risky gamble. On the other hand, nicer sleeping in my own bed than in the hospital!

  7. When my kids were little and my husband travelled I paid their baby sitter to sleep in the guest room on the nights I had call. Only remember having to go in once, but it was worth the price because whatever sleep I got was better

  8. I've been on call pretty much continuously for 8 years, in solo practice. You get used to it.

  9. I agree with anonymous. I am a neurologist and am on call six months of the year. Just always have your pager and cell phone and then try not to think about it.

  10. I'm a group practice midwife, oncall 5 days a week and have just started the same 'beeper phobia'. I've hallucinated the phone ringing, messages arriving - will just be dozing off when I jerk awake panicking that I don't have the phone...and yet I've done this job for almost 6 months and have just started this problem. I don't know why, but can totally empathise with you. Just hope I can get my sleep pattern back, or i might need to return to mainstream midwifery - shift work sucks too, but at least there's no oncall....


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