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 generallymedicine.com March 19, 2011