Anybody else feel this way??

i felt like that quite often - but i knew that after internship i'd be doing anesthesia, where i would never ever have to go to the ER other than for something truly exciting And since starting Anesthesia residency, I can proudly say i have never received any of the following pages anymore

1) "i know it is 2am, but can you come up and examine Mrs. So-and-So's rash on her left arm... i know she has had it for 2 weeks, but it looks concerning right now"
2) "sorry doc, i know it is 1am, but i was going through the orders and i noticed that there are no orders for bowel regimen.... I know he isn't constipated right now, but you never know"
3) "we lost your orders on that stroke patient ... the long list of orders you wrote at 9pm, and now it is 3:20 am, so can you come back down to the ER and re-write them??"
the list goes on, and on

A few of my favorites:

1. At 3 am: "Doctor, I know this patient has been here for 5 days, but I was wondering what the long-term treatment plan for the patient is. Oh yeah, and what is his prognosis?"
2. The fun 4 am call from Pharmacy: "Doctor, you put in this order at midnight for vancomycin q48hours, but because of her renal failure, will you you check a pre-dose vanco level in two days?"
3. The 1 am call for a cross-cover patient I've never met: "Doctor, this patient who has been here for 2 weeks has his family here, and they want to talk with you.... no, doctor, nothing's going on. I think they want to talk about what your plan is. I know he's not your patient, but can you come down right now?"

I don't include the times in the quotes, because I don't think that the various people who make these types of calls ever stop to think what time it is.

Yes, internship can be frustrating, but once you become a resident (particularly in medicine), you will have interns under you who will take care of much of the annoying stuff...

Hey hey don't forget after the initial phone call, you get the call 3 minutes later that says "I'm sorry doctor, what was your name?" I get that every night atleast twice.

I only have ONE more call month to go (MICU) and then I am free forever! Ah, the joys of EM.

Q, DO

It's hilareous that the same things are heard by every resident in every hospital across north america! A few more of my favorites"

"just wanted to let you know that Mr. X's electrolytes from this morning are normal" (2am page)

"YOU HAVE TO COME TO THE FLOOR STAT.. MR. X'S CREATININE IS CRITICALLY LOW"


Everyone feels like throwing in the towel at 3 am when you're getting burried in crap consults and have idiots paging you nonstop. Just keep the big picture in mind and realize that this phase is temporary.

1. "Sorry, we don't do ear lavages. He had a perforation." "That was SIXTY years ago. Last ENT check he was just fine" "Sorry, as a policy, we don't do ear lavages on folks with perforations" "But he's not perforated!" "Sorry, but he has a history..." "SIXTY YEARS AGO!"

2. (This is with a respiratory therapist) "Doc, I am sucking up some blood when I'm suctioning" "How far down are you going?" "Well, as far down as I need to" "It's probably from the trauma then" "But it's so unusual to see blood... can you check her hemoglobin to make sure she's not having a GI bleed and aspirating that?"

At 3am, "Can Ms. X go back on her birth control pills?"
(The reply, "is she having sex right now!?")

At midnight, stat page to the floor, "Baby X is failing to gain weight."

More actual 3am-ish calls

1. "The patient was feeling a little nauseous so I gave hime some Reglan, so now I just need to get an order for that"


2. "This patient takes a weekly medication that wasn't ordered. She's not due to get it again for four days, but I just thought if we could get the order in now it will save the primary team from having to do it in the morning." (Seriously)


3. NURSE: "are you covering for dr. so-and-so?"
ME (still half-asleep): "No that's someone else"
HER: "Well, while I have you now, could you put in a tylenol order for me for that patient? I'd hate to have to wake someone up for something so minor."
ME (Not actually saying) "No ****"
ME: "There's no prn tylenlol already ordered?"
HER: "Well, yes but it's only written for a temp over 100.5"
ME: "So.....What's the patient's temp?"
HER: "99.4.... but he was 98.6 just this morning so it's a significant change."
ME: @*#$%!!!! (click.)

(I wish I were making this stuff up)

I've now stopped answering all pages. It makes internship slightly more bearable.

Someone else said-
RN at 3 AM- hi doc pt X has a low BUN as I can see in the automated comp system.
Doc- (sleepily) give some extra BUN IV stat

RN at 3 am: Sorry to bother you Doc but Mr X cant stop coughing

at 1 am
RN: "Doctor, Mr. Y's BP is 130/80, he is due to get his hydralazine, should I hold it?

Me: "His BP is 130/80, I think we can give the medicine, what do you think?"

Loved that call. Glad to get up for that one.

3AM
RN: "Mr. Smith's Demerol expired at midnight, can I get a reorder?"
Me: "Is Mr. Smith awake?"
RN: "No."
Me:"Did Mr. Smith complain of pain lately?"
RN:"No."
Me:"#@&#%!!

4AM
RN: "Ms. Smith's ICP is 30 and her last serum osmol was only 290, can we give her some more mannitol?"
Me:"Sure, give her 75"
RN:"Oh...well we only have 4 bottles here, how about 50 instead??"
Me: "@&$^!!"

3AM
RN:"Hi Dr. X, sorry to bother you at this hour but I've noticed that Mr. Smith's urine output has been 25-30 cc/hr"
Me:"How long has it been 30 cc/hr?"
RN:"Since 7pm when I came on shift."
Me:"Why are you just now calling a Dr.?"
RN:"Well I gave him a 250 cc bolus of NS around midnight and nothing happened. Oh by the way, can I get a verbal for that?"
Me:"$*#$^!#@!!!
(I didn't really curse but you get the idea)

Originally posted by JPFL75
"Dr. sorry to bother you...but the patient is having a headache..the order for tylenol is PRN..do you think I can give it?"

"Hey doc..I know it's 4 AM but I gave the patient 1 tyelnol instead of 2 tylenol for her head ache..is that gonna be ok?" Same nurse as above

"excuse me dr., but Mrs Smith is hungry now can I feed her...oh yeah sorry to bother you at 2 AM." this is a call for a patient that's going for surgery in the AM and I wrote an order for NPO after midnight

the list goes on...please feel free to add your most memorable and POS call that you've gotten while on-call

Click to expand...

You have pissed off this nurse. These are classic examples of nurse tactics used to punish an intern.

Here is what you do:
DO NOT lose your temper or raise your voice. Calmly listen to what she has to say. Collect yourself and address whatever concern it is she's calling about. Then (this is the important part) thank her for calling. Tell her that, in fact, you're very glad that she happened to call when she did, because it reminded you of some things that you need done. Then give her a list of three things to do. Simple things like "check and record a set of three BP's 15 minutes apart; do hourly urine output recordings over the next 8 hours, flush and irrigate the NG tube with a recording of infusate and drainage every two hours tonight..." Make certain that it's something that has to be recorded so she can't just say that she did it.

It's very important that you do this in a pleasant, professional manner. Otherwise she'll clue into the fact that you're being punative and she'll be able to turn it around on you.

You'll only need to do this maybe twice, and after that your nightime pages will be genuine patient care issues only.

I second that. Three "useless" tasks for every inane page and the RNs will quickly learn when it is appropriate to page you. I loved doing that as an intern, but only with the nurses that were complete idiots. I remember many occasions of having to patiently explain at 3am that my orders were not recommendations.
PMMD

Originally posted by Tenesma
3) "we lost your orders on that stroke patient ... the long list of orders you wrote at 9pm, and now it is 3:20 am, so can you come back down to the ER and re-write them??"
the list goes on, and on

Click to expand...

That happened to one of my residents after I wrote 2 pages worth of orders. I kept a copy of them (because it makes it easy to tell the attending what you're doing for the patient).

The funny thing was we were in the conference room when the nurse paged at 2 am. We were watching a late night movie. It really got interesting when the resident asked me for the copy of the orders, and then told the nurse "Here, I'll just give them to you now. Got a pen and an order sheet?" Funny thing how the nurse found the orders when she went to get a blank order sheet. How coincidental is that?

Hmmmmm...I have a couple of specific clueless nurses for which I will plan to implement the "three useless tasks" strategy. I am almost ashamed I had not thought of it myself! As Nat mentions above, I have leanred, the hard way, that being too attentive can be very counter-productive to sleeping. Having had a 10+ year career as a resp terrorist, I had the most golden of intentions of being a highly attentive resident. Alas, my intent undermined my own sanity when I realized I was getting loads of requests from RNs & RTs that they simply were not giving to the primary team. They knew the primary team woulld likely not be as receptive or had already vetoed the idea. So, let's just call OldManDave.

Now, I am still 200% attentive to the patients IN NEED. But, I have a new filter. My job, as the on-call resident, is to put our fires...if it ain't on fire, please refer your request to the primary tema in the morning. If there is a fire, even if it is only a tiny smoldering affair, I will deal with it promptly & with the best skills I can bring to bear.

Now for some humorous actual calls:

@ 11:55 - Lab: "Mr so & so's blood cx are positive for xxx" as they have been for two weeks
ME: thank you for the info, but they have been positive for 2+ weeks
later, that same night, same lab attendant @ 2:30 - Lab: "Mr so & so's 2nd bottle of 4 is positive"
ME: do you realize that not only have they been positive for 2+ weeks but that it is 2:30 in the morning?
Lab: But I thought you guys worked night...
ME: We do 30 hours shifts on call & enjoy what precious little sleep we can
Lab: Oh, so do you not want to be called about these sorts of things at night?

1am: "Sorry to bother you Doc, but the Ortho resident forgot to order something & I need you to take care of it"
Me: May I ask what that might be & which patient?
RN: "He forgot to place a PPD on Ms. XYT & I wanted to know if you could come do it now?"
Me: No <<click>>

@0400: "Dr, I amsorry to bother you, but aren't you covering for NeuroSurg?"
ME: Yes
RN: "Well, Mr. XYZ, you know that guy whose been in a coma for 2 months & is on comfort care only?"
ME: No, I am only the cross cover & I am not on that service, but is there a problem?
RN: "Yes, I was checking his pupils..."
ME: at 4 in the morning on a CMO, vegitative pt?
RN: "Yes, and they are not reactive!"
ME: Have they been?
RN: "Well, it is charted that were not, but I thought I had seen them work earlier; so I wanted to call to report to you that there was a change"
ME: Thank you, good night