Tuesday, April 1, 2008
Paging Dr Buckeye......
I get a lot of pages during the day. That's part of the deal if you want to be a general surgeon. I start checking the batteries if it hasn't gone off in a couple hours. You pretty much memorize where the numbers are coming from after a while, and you can often predict which nurse is calling about which patient. I love when the ER calls (something fresh and exciting!) Pages from the ICU make me nervous, especially with regards to post-op patients. Direct calls from other doctors can be good or bad. It could be the GI guy who wants you to know about a colon cancer he just scoped. Alternatively, it could be the internist who needs you to see a perianal abscess "stat". That's the life. You never know what is going to show up. There are certain pages at specific times of the day, however, that, without a Herculean effort of self-control, would lead to a melt down of epic proportions on my part (think Dennis Green after that Monday night game between the Bears/Cardinals a few years ago.)
5) The page to a floor I just left about a patient I just saw and wrote a note/orders on. I usually will try to find the nurse when I make rounds on a patient, inform her/him of the plan, ask if there are any issues, just to avoid this sort of page. But I still get it occasionally. "Dr Buckeye, did you want that dressing change done wet to dry or just dry?"......after she just watched me pack a wound with gauze.
4) The page for a consult when I'm half way home and half starving to death. Then you have to pull over, dig out your phone and try and figure out if it's something that needs to be seen stat (acute abdomen) or perhaps can wait until the morning (80 year old lady with constipation).
3) The nurse who pages you 5 times in an hour about a multitude of minor details. It's usually a younger nurse in the ICU. First they call about pain meds. Then, they see the potassium is 3.7. Then, they just want to know of they can use the NG tube to give meds. Then, it's a question about the rash on the patients neck. After the fifth call, I'lll usually make the nurse go through all her notes and charting and make sure there isn't ANYTHING ELSE before I hang up.
2) The call at 6:30 AM about a patient's low urine output or tachycardia or some other sphincter tightening issue in a post-op patient. Here's the deal: nurses have shift change at 7AM. I'm not stupid. The incoming nurse will ask," did you call Dr X about the urine output?". The 6:30 AM call allows the leaving nurse to say "of course". But it's half assed. How long has the urine output been low? Since last night, you hear. Well, why didnt you call me about it earlier, I ask? I didn't want to wake you up in the middle of the night...... Early intervention is the key for things like volume depletion and arrythmias and pulmonary embolism. The astute nurses don't do crap like this.
1) Calls between 2:30 and 3:30 in the morning. This is the witching hour. My brain is a seeping ball of mush at this time. Unless I hear the words "free air" or "appendicitis" or "peritonitis" you arent going to get much intelligible out of me. Moans and grunts if you're lucky. Half the time, I look at the pager, see I got a call at 3:17AM and can't for the life of me remember what the hell it was about.
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I agree with you about that 2:30 - 3:30 am time. It is tough to get the brain working then.
This is the 2nd time I have come across your blog. I enjoy your humor! I am a student at GateWay CC studying medical transcription (I hope you speak clearly when dictating! ha). The surgeries you mention here are interesting to read about, especially with the details you give. I like your rundown about the pager and not remembering what it was all about the next morning...I can only imagine!
Great post. Being in the middle of my surgical training at a big academic center, I can't imagine our attendings getting these pages. Every one of those pages would go to us. We seem to function as relatively reliable filters for the attendings. Only after the UOP hasn't improved with boluses, foley flushes, hct checks, creatinine checks, ICU transfers, etc would it be bumped up in the middle of the night. Having trained at Cook County, you must remember those days. Do you have any housestaff at your hospital? Do you ever wish you did or do you enjoy running your own show?
I don't have residents. Despite the whiny tone of my post, I actually don't mind getting paged, for the most part. It's my patient, I'm responsible. One thing you better lose as you become an attending is the sense that some issues are "below you". I like knowing that the potassium is 3.1. There's no intern to call. I fix it. I'm the boss, buddy.
We have one attending who forgets the 3am pages so thoroughly that some residents have taken to getting witnesses to the fact that they talked to him, so he can't accuse them the next day of managing a major emergency without letting him know.
This is why I never, ever, ever page the bf for anything when he is at work--I'd rather not be associated with that "evil thing." :-P
Well, unless it was a complete emergency, of course, which (knock on wood) has not yet happened.
I am lucky that his late night pages when he is on call do not wake me up at all. Then again, I am an extremely deep sleeper. :)
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