Call night

I turn in the bed once more, shaking off half-lucid nightmares of medical errors and angry nurses. I’m working the “night admitter” shift tonight, which means I am responsible for any new admissions to the hospital from 7 PM to 7 AM. It also means that once the emergency room quiets down, I can usually escape to the call room to get some sleep, which is exactly where I find myself now.

This particular call room is tucked away in the fourth floor of Boston’s West Roxbury VA Hospital. Unlike most other call rooms, this one has six beds rather than just one. If falling asleep in a hospital overnight isn’t challenging enough, try doing so in a room full of anxious young doctors.

In the far corner is a resident I don’t recognize. He has been asleep since I walked in hours earlier, and he hasn’t woken up once since. I’m starting to wonder if he’s even working tonight or if he maybe just forgot to go home.

In the other corner is a resident who is the “nocturnist” — his job is to care for all of the patients in the hospital, which he does by fielding pages from the nursing staff as things arise during the night. I promise you his job is as difficult as it sounds.

I know this because every thirty minutes or so, his pager alarms again, signaling another request from another nurse about another patient. The blare of each page is rhythmically followed by the groan of my colleague — “Come on..” he exclaims this time with a frustrated sigh. Within minutes, he is logged into the computer, dissecting the chart of yet another patient he has never met.

I glance down at my own pager. I’m proud of it for being quiet, and I silently judge my colleague for having a pager that is so poorly behaved. I like to pretend that we each raised our pagers to act they way they do.

I reminisce; the first page I ever received was during my first rotation of my third year of medical school — the beginning of my excursion into clinical practice.

During the second week of the rotation, I was assigned my very own patient. Well, to be clear, this wasn’t really my own patient — he was also being cared for by my intern, and my intern’s resident, and my resident’s fellow, and my fellow’s attending. One afternoon (for a reason I can no longer remember), I was instructed by my resident to check on our patient’s vital signs. As a resident now, I realize that this was just a cleverly designed task to help me feel included. But at that time, the task was monumental. I remember walking briskly through the hallway to my patient’s room with a sense of determination and importance that I rarely muster these days.

I arrived at the patient’s floor and asked the nurse to check the vital signs. She agreed and even offered to page me with the results. At the time, I didn’t know this was an option (and she didn’t know I was just a medical student), but I quickly accepted — “Sure, that will be great,” I replied before turning around to leave, pretending that I had other matters to attend to.

I returned to our work station and waited for her page. Ten minutes became two hours, and the darkness outside began to invade into our room. I clicked through my pager one final time, yet still no pages. I sighed, grabbed my backpack and headed out for the day.

As I pulled out of the parking lot, I felt a buzz at my right hip followed by a chirping noise. The disruption startled me, but I gathered myself and unholstered the pager, palming it into my right hand in one smooth motion like I had seen so many residents do. In archaic font, the pager signaled “1 new message.” I clicked: “Vital signs: BP 142/75, HR 88, RR 22, O2 98% RA.” For the first time that day, I realized that I had absolutely no idea what to do with these numbers or why I was even asked to get them, but I felt filled with excitement. Someone had reached out to me for my help. I was becoming a doctor.

I have since received thousands of pages. Many have woken me up, and some have broken me down. At times, they have interrupted a heartfelt bedside conversation, and at others, they have allowed me to excuse myself from a dry lecture.

A few have contained good news: “The enema worked, Mr. B finally had a bowel movement, no disimpaction needed!” Others have brought with them a cloud of darkness: “Re: Ms. Johnson. MRI read finalized, the cancer has spread to her brain…” Some have set my heart racing, “Dr. Al, patient’s O2 saturation is in the 70s, she says she can’t breathe, please hurry!” While others have disrupted a fun-filled weekend, “Hey Muthu, we’re going to need you to cover tomorrow, Joanne missed her flight.” In many ways pages are magical, because in the three seconds between hearing the noise and opening the message, you have no idea which of the above emotions you are about to experience.

For decades in this profession, we have used the dim light of a dark rectangular box to share heartbreak and happiness. We have used it to discuss new findings with old friends. And we have used it to recount the major turning points of millions of lives, all in 140 characters or less.

Well who would have thought.. we were tweeting long before twitter.

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