Overnight pages - memorable/dismal/ridiculous/unique

[dpmd]

Finished ex-lapping the Pt around 7pm. Order PCA then. Big incision, big surgery. Pt does fine in PACU, gets to floor. Keeping him NPO for the night, will need to reassess in the AM.

1am, nurse. "Hello, I was calling to see if we could DC the PCA on Pt Xlap."
Me (super bleary, must have been deep in REM...):"Whaaaa...?"
Nurse: "His pain is well controlled. Could we switch to oral meds?"
Me: "Whaaattt? I don't understand. I ordered a PCA. Why do you want it canceled?"
Nurse:"He hasn't used much. (Snippy, defensive tone). I just thought we should save the PCA pumps for appropriate pain control for someone else who might need it."
Me:"He had a big surgery. It's a PCA. I'm just not understanding....why do you want to cancel it?"
Nurse Snippy: "Well, if you want to keep it, I guess we can, I just want to make sure we have PCA pumps for appropriate pain control for patients who might need it."
Me: "Ok, we'll keep it for now. Thank you."


I still don't know, man. Never had a call like that before. Sometimes people complain that it beeps, but that wasn't the case here. Seems like nurse thought there was going to be a 1AM mad rush for the PCA pumps. I checked my pager in the later AM, and it wasn't just a bad dream...

Oh, and following morning, Pt said his pain was well controlled and the PCA was working great for him...

My guess is that there already was a shortage of pca machines and you weren't the only one to be awakened to try and free one up. That or there was a shortage of filled syringes and that was the time a new one was going to be needed

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[evilbooyaa]

Finished ex-lapping the Pt around 7pm. Order PCA then. Big incision, big surgery. Pt does fine in PACU, gets to floor. Keeping him NPO for the night, will need to reassess in the AM.

1am, nurse. "Hello, I was calling to see if we could DC the PCA on Pt Xlap."
Me (super bleary, must have been deep in REM...):"Whaaaa...?"
Nurse: "His pain is well controlled. Could we switch to oral meds?"
Me: "Whaaattt? I don't understand. I ordered a PCA. Why do you want it canceled?"
Nurse:"He hasn't used much. (Snippy, defensive tone). I just thought we should save the PCA pumps for appropriate pain control for someone else who might need it."
Me:"He had a big surgery. It's a PCA. I'm just not understanding....why do you want to cancel it?"
Nurse Snippy: "Well, if you want to keep it, I guess we can, I just want to make sure we have PCA pumps for appropriate pain control for patients who might need it."
Me: "Ok, we'll keep it for now. Thank you."


I still don't know, man. Never had a call like that before. Sometimes people complain that it beeps, but that wasn't the case here. Seems like nurse thought there was going to be a 1AM mad rush for the PCA pumps. I checked my pager in the later AM, and it wasn't just a bad dream...

Oh, and following morning, Pt said his pain was well controlled and the PCA was working great for him...

Just let him/her know you'll be happy to switch the order to IV Morphine 2mg q10 minute PRN instead since they want to save the PCA pumps. And that they better be right there to administer it everytime he presses the pain button, and that you expect q10 minute pain evaluations on the patient.

 

[WinslowPringle]

My guess is that there already was a shortage of pca machines and you weren't the only one to be awakened to try and free one up. That or there was a shortage of filled syringes and that was the time a new one was going to be needed

There isn't a shortage of the pre filled syringes; also it was still early enough in the course with the dosing I had written that he would have had his initial syringe (which I confirmed on following AM rounds).
We do sometimes have a shortage of the pumps, but it didn't sound like it was an acute need like someone else was actively needing a pump and when that is the case you usually get notified by pharmacy when you order it (which had been hours earlier) ...also, he already had the pump and I'm pretty sure that big ol' ex lap in a strict NPO pt should probably get priority. He kept the pump for another ~30hr before transitioning to PO and I didn't hear another peep about it. The call also came in the "wee sma hours...." and I know (it's a small enough "big" hospital and I was taking calls for all general surgery and related services for the entire hospital) there were no other surgeries that had finished in the interim, no other surgical admissions that would require one, no anesthesia PCA/epidural pain service....so the overall likelihood of there being an acute need for a bunch of pumps at that time of night without my having heard about it is fairly small. Hence some of my confusion and pretty much ability to just mumble "Whaaaaaaa...?"

 

[TraumaLlamaMD]

There isn't a shortage of the pre filled syringes; also it was still early enough in the course with the dosing I had written that he would have had his initial syringe (which I confirmed on following AM rounds).
We do sometimes have a shortage of the pumps, but it didn't sound like it was an acute need like someone else was actively needing a pump and when that is the case you usually get notified by pharmacy when you order it (which had been hours earlier) ...also, he already had the pump and I'm pretty sure that big ol' ex lap in a strict NPO pt should probably get priority. He kept the pump for another ~30hr before transitioning to PO and I didn't hear another peep about it. The call also came in the "wee sma hours...." and I know (it's a small enough "big" hospital and I was taking calls for all general surgery and related services for the entire hospital) there were no other surgeries that had finished in the interim, no other surgical admissions that would require one, no anesthesia PCA/epidural pain service....so the overall likelihood of there being an acute need for a bunch of pumps at that time of night without my having heard about it is fairly small. Hence some of my confusion and pretty much ability to just mumble "Whaaaaaaa...?"

Gotta love it... “yes, his pain IS well controlled on the PCA. But sure, let’s experiment with that at 1am.”

 

[HighPriest]

Finished ex-lapping the Pt around 7pm. Order PCA then. Big incision, big surgery. Pt does fine in PACU, gets to floor. Keeping him NPO for the night, will need to reassess in the AM.

1am, nurse. "Hello, I was calling to see if we could DC the PCA on Pt Xlap."
Me (super bleary, must have been deep in REM...):"Whaaaa...?"
Nurse: "His pain is well controlled. Could we switch to oral meds?"
Me: "Whaaattt? I don't understand. I ordered a PCA. Why do you want it canceled?"
Nurse:"He hasn't used much. (Snippy, defensive tone). I just thought we should save the PCA pumps for appropriate pain control for someone else who might need it."
Me:"He had a big surgery. It's a PCA. I'm just not understanding....why do you want to cancel it?"
Nurse Snippy: "Well, if you want to keep it, I guess we can, I just want to make sure we have PCA pumps for appropriate pain control for patients who might need it."
Me: "Ok, we'll keep it for now. Thank you."


I still don't know, man. Never had a call like that before. Sometimes people complain that it beeps, but that wasn't the case here. Seems like nurse thought there was going to be a 1AM mad rush for the PCA pumps. I checked my pager in the later AM, and it wasn't just a bad dream...

Oh, and following morning, Pt said his pain was well controlled and the PCA was working great for him...

There isn't a shortage of the pre filled syringes; also it was still early enough in the course with the dosing I had written that he would have had his initial syringe (which I confirmed on following AM rounds).
We do sometimes have a shortage of the pumps, but it didn't sound like it was an acute need like someone else was actively needing a pump and when that is the case you usually get notified by pharmacy when you order it (which had been hours earlier) ...also, he already had the pump and I'm pretty sure that big ol' ex lap in a strict NPO pt should probably get priority. He kept the pump for another ~30hr before transitioning to PO and I didn't hear another peep about it. The call also came in the "wee sma hours...." and I know (it's a small enough "big" hospital and I was taking calls for all general surgery and related services for the entire hospital) there were no other surgeries that had finished in the interim, no other surgical admissions that would require one, no anesthesia PCA/epidural pain service....so the overall likelihood of there being an acute need for a bunch of pumps at that time of night without my having heard about it is fairly small. Hence some of my confusion and pretty much ability to just mumble "Whaaaaaaa...?"

plus, if they really needed a pump she could open with that. “Hey, doc, I know you wrote a PCA for this guy. But we have a patient who really needs one and we literally don’t have any. Can we D/C this one because he isn’t using it?”

Different situation.

 

[Merely]

Early enough in the morning I'm still at home, asleep...
Me: "Hello, WinslowPringle with Surgery, returning a page."
Nurse: "Hello, are you taking care of Patient X in room Y?"
Me: "Not any more, we were consulted but signed off a few days ago."
Nurse: "Oh. Well, I saw your name in his chart."
Me: "Yes, I saw him a few days ago, but not today. We were consulted for [elective surgical procedure P], but didn't due to [host of risks and contraindications]."
Nurse: "I was looking for who to call, and I saw your name in his chart."
Me: "I'm not taking care of this patient."
Nurse: "Oh. Well. But you had seen him."
Me (internal sigh): "What are your concerns?"
Nurse: "He just flipped into a fib with RVR. Would you like me to start an amio drip?"
Me: "You'll need to call his admitting team - he's admitted to Internal Medicine. I'm a general surgery resident and I haven't seen him recently and we aren't going to operate on him, and haven't recently operated on him."
Nurse: "Do you know who the Internal Medicine attending on him is?"
Me: "No. You'll have to look in his chart. I'm not at a computer right now."
Nurse: "Oh. Ok."


(There is an Internal Medicine HP, daily Internal Medicine progress notes, all the orders are from Internal Medicine, the Internal Medicine attending is listed under 'calls to' order as well as the 'admit' order, and in the right upper screen of the patient's EMR...My name was on two progress notes and zero orders....)

OMG I’m sorry but that’s literally so funny and sad

 

[Jolie South]

Finished ex-lapping the Pt around 7pm. Order PCA then. Big incision, big surgery. Pt does fine in PACU, gets to floor. Keeping him NPO for the night, will need to reassess in the AM.

1am, nurse. "Hello, I was calling to see if we could DC the PCA on Pt Xlap."
Me (super bleary, must have been deep in REM...):"Whaaaa...?"
Nurse: "His pain is well controlled. Could we switch to oral meds?"
Me: "Whaaattt? I don't understand. I ordered a PCA. Why do you want it canceled?"
Nurse:"He hasn't used much. (Snippy, defensive tone). I just thought we should save the PCA pumps for appropriate pain control for someone else who might need it."
Me:"He had a big surgery. It's a PCA. I'm just not understanding....why do you want to cancel it?"
Nurse Snippy: "Well, if you want to keep it, I guess we can, I just want to make sure we have PCA pumps for appropriate pain control for patients who might need it."
Me: "Ok, we'll keep it for now. Thank you."


I still don't know, man. Never had a call like that before. Sometimes people complain that it beeps, but that wasn't the case here. Seems like nurse thought there was going to be a 1AM mad rush for the PCA pumps. I checked my pager in the later AM, and it wasn't just a bad dream...

Oh, and following morning, Pt said his pain was well controlled and the PCA was working great for him...

My favorite is when I have an open AAA in an old sick person, with supraceliac clamp and the ICU team decides POD1 to dc the PCA and give PO norco. Like what in the actual f***. I had LASIK once and took a Vicodin on an empty stomach and vomited. This dude had all the blood supply to his bowel clamped for a period of time not to mention packed off with towels and a retractor. Biggest pet peeve ever.

 

[LucidSplash]

My favorite is when I have an open AAA in an old sick person, with supraceliac clamp and the ICU team decides POD1 to dc the PCA and give PO norco. Like what in the actual f***. I had LASIK once and took a Vicodin on an empty stomach and vomited. This dude had all the blood supply to his bowel clamped for a period of time not to mention packed off with towels and a retractor. Biggest pet peeve ever.

This. All my aortas are done retro but still. I end up writing an order that says “strict NPO unless ordered otherwise by vascular service.”

See also, d/cing the NGT on my mesenteric bypasses on POD 1 and then being surprised when they aspirate.

 

[dpmd]

This. All my aortas are done retro but still. I end up writing an order that says “strict NPO unless ordered otherwise by vascular service.”

See also, d/cing the NGT on my mesenteric bypasses on POD 1 and then being surprised when they aspirate.

At least that is a safe ngt to reinsert. Could be worse, they could be dc'ing the ngt that was carefully positioned by a repair or through a anatomical anomaly that means no new ngt. Or taking out your Foley from the freshly repaired bladder or that took urology special effort to place it due to anatomy as well.

 

[LucidSplash]

At least that is a safe ngt to reinsert. Could be worse, they could be dc'ing the ngt that was carefully positioned by a repair or through a anatomical anomaly that means no new ngt. Or taking out your Foley from the freshly repaired bladder or that took urology special effort to place it due to anatomy as well.

Yeah, true. But having your aorta or mesenteric patient aspirate and get ARDS and die is a great way to snatch defeat from the jaws of victory.

 

[Jolie South]

Yeah, true. But having your aorta or mesenteric patient aspirate and get ARDS and die is a great way to snatch defeat from the jaws of victory.

I have had way too many open aortas die this way.

 

[310prolene]

At least that is a safe ngt to reinsert. Could be worse, they could be dc'ing the ngt that was carefully positioned by a repair or through a anatomical anomaly that means no new ngt. Or taking out your Foley from the freshly repaired bladder or that took urology special effort to place it due to anatomy as well.

Took a ptient to OR on Saturday. Urology had to come in to put the foley in, which required 45 minutes of cystoscopy to get placed. Patient gets up to floor after OR. Receive page from RN, “patient now has Foley, didn’t have prior to OR. Should I remove?”

 

[LucidSplash]

Took a ptient to OR on Saturday. Urology had to come in to put the foley in, which required 45 minutes of cystoscopy to get placed. Patient gets up to floor after OR. Receive page from RN, “patient now has Foley, didn’t have prior to OR. Should I remove?”

At least they contacted you first!

 

[WinslowPringle]

(Patient had surgery and so has Tylenol, oxycodone, ibuprofen, morphine, ice and heat packs available.)

Nurse: "Pt is complaining of new, right sided chest pain."
Me: "When did it start? Any other symptoms? Vitals?"
Nurse: "No other symptoms. Vitals are [the most within-normal-parameter vitals in the hospital]. She says it feels like her muscle hurts; it started after she pulled herself up in bed, she says she thinks she strained grabbing the handrail. Pain is about a 3 and its reproducible when I press along that area."
Me: "Ok, have pain meds made a difference?"
Nurse: "She hasn't had any recently. Should we try some?"
Me: "Yes."
Nurse: "Ok. I'll keep you updated!"

Didn't hear back. Thankfully, tylenol to the rescue!

 

[WinslowPringle]

Patient uses albuterol "1-2" puffs q4hr PRN wheezing at home; I go through the worse-than-CPRS emr at Corporate Conglomerate Hospital to continue this life saving med in the hopes of staving off another page of "Pt wants her home meds..." and it automatically continues and selects "1-2 puffs" albuterol q4hr PRN wheezing. Fine and dandy. Same as at home, reasonable dosing, all hunky-dory.

The pharmacist then pages me just as I fell asleep at midnight (two hours after the orders were placed, after an 18hr day), to inform me "We can't do range dosing." Never mind that it's an auto-population in this EMR. Never mind that yes we can and do do range dosing all the time (and the pt has other range doses on her MAR...)

I told her to change it to 1.5 puffs.

She didn't find that funny.

I wasn't joking.

 

[dpmd]

Patient uses albuterol "1-2" puffs q4hr PRN wheezing at home; I go through the worse-than-CPRS emr at Corporate Conglomerate Hospital to continue this life saving med in the hopes of staving off another page of "Pt wants her home meds..." and it automatically continues and selects "1-2 puffs" albuterol q4hr PRN wheezing. Fine and dandy. Same as at home, reasonable dosing, all hunky-dory.

The pharmacist then pages me just as I fell asleep at midnight (two hours after the orders were placed, after an 18hr day), to inform me "We can't do range dosing." Never mind that it's an auto-population in this EMR. Never mind that yes we can and do do range dosing all the time (and the pt has other range doses on her MAR...)

I told her to change it to 1.5 puffs.

She didn't find that funny.

I wasn't joking.

You can do ranges but only if you give parameters. Should have known better.

 

[WinslowPringle]

You can do ranges but only if you give parameters. Should have known better.

Parameters for range dosing for this med aren't exactly an option in this particular EMR. And if we can do range dosing but with parameters, I should have been able to give an order for 1 puff followed by a second puff if first puff not providing wheezing relief within five minutes or some such parameter. And if we "can't" do range dosing period, it shouldn't be an auto-population in the EMR. It's a systems, mainly terrible EMR, issue.

 

[WinslowPringle]

Nurse [calling from cardiology-dedicated floor]: "Hello, I'm calling on pt Dilalapenia. He's the guy admitted for STEMI several days ago; you guys were consulted for that femoral pseudoaneurysm after heart cath. Anyways, he's having a lot of neck pain. He says it's sharp but kind of achy and it hurts all over. It's keeping him from sleeping. He thinks it's because he slept wrong on it earlier today. I've already given him some tylenol and oxycodone and he doesn't have anything stronger ordered. I just think this is unacceptable pain for him and wanted to give him something stronger."
(This is a pt we've seen and signed off on, the last note from the day prior from another resident on the service specifically says no vascular interventions and pseudoaneurysm is now without flow; I've never seen the patient.)
Me: "Interesting. Could you tell me why you're calling me?"
Nurse (speaking slowly so the stupid surgery resident understands the importance of stronger narcotics): "He is having neck pain. I think he needs dilaudid."
Me: "I meant....we're consulted for a possible femoral pseudoaneurysm. Is he having groin pain?"
Nurse: "No, like I said, it's in his neck."
Me: "I don't think this is related to the possible issue we were consulted on. He's admitted to another team; I just don't think I'm the best person to order that. Also, we've signed off. I think the best person to call would be someone from the primary team."
Nurse: "But he's having pain."
Me: "And I'm uncomfortable prescribing more narcotics on a patient I haven't personally seen for a reason my team hasn't seen him for, particularly after we've signed off."
Nurse: "But..........(Audible sigh and nearly visible eye roll through the phone lines). Fiiiine."


(The reason she was calling me was totally because there are no cards fellows on that service, the NPs are gone after 5pm, and no way did she want to call the private attending for neck pain at that time of night.)

 

[WinslowPringle]

Pt had indications for combo anticoagulation and antiplatelet medication; was hospitalized for a few weeks and finally discharged after a complicated vascular/pulmonary/cardiac course of events.

After hours, weekend out of town pharmacist call: "Patient [Billy Bob] that you discharged about a week ago just came in to fill his xarelto and aspirin."
Me: "Great."
Pharmacist: "I just wanted to check with you - did you know the combination of these can increase the risk of bleeding events?"
Me: "Yes."
Pharmacist: "And you still want me to fill them?"
Me: "Please do."


(Not an unreasonable call to verify the rx - it was memorable because of how he specifically asked if I knew that they would increase bleeding risk. Four years of medical school, five years of surgical residency with four months of vascular and nine months of trauma baby sitting 90 year old head bleeds on every combination of anticoagulation/antiplatelet therapy imaginable and - yes, yes I do know that )

 

[WinslowPringle]

I think I must have pissed this nurse off....she called me 7 times between 11pm and 2am. Granted, patient was sick but appropriate orders were in place, on abx, and the cause of the sickness had been surgically treated.
The final 2am call:

Nurse: “Hi, this is Nurse Caller, I’m taking care of........let’s see, patient Hadabig Bellycut in ICU11.”
Me: (inside my head - yes, I know. I have you on speed dial now...)
Nurse: “I just took his temperature. It’s (cold)....should I give him warm fluids and give him a warm blanket?”
Me: “......Yes.”
Nurse:”Thanks, just wanted to check.”

 

[swoopyswoop]

I think I must have pissed this nurse off....she called me 7 times between 11pm and 2am. Granted, patient was sick but appropriate orders were in place, on abx, and the cause of the sickness had been surgically treated.
The final 2am call:

Nurse: “Hi, this is Nurse Caller, I’m taking care of........let’s see, patient Hadabig Bellycut in ICU11.”
Me: (inside my head - yes, I know. I have you on speed dial now...)
Nurse: “I just took his temperature. It’s (cold)....should I give him warm fluids and give him a warm blanket?”
Me: “......Yes.”
Nurse:”Thanks, just wanted to check.”

Maybe time for the charge nurse to have a discussion about appropriate physician paging overnight.
That said, the ship seems to have already sailed. God speed on this journey ahead of you.

 

[akwho]

I think I must have pissed this nurse off....she called me 7 times between 11pm and 2am. Granted, patient was sick but appropriate orders were in place, on abx, and the cause of the sickness had been surgically treated.
The final 2am call:

Nurse: “Hi, this is Nurse Caller, I’m taking care of........let’s see, patient Hadabig Bellycut in ICU11.”
Me: (inside my head - yes, I know. I have you on speed dial now...)
Nurse: “I just took his temperature. It’s (cold)....should I give him warm fluids and give him a warm blanket?”
Me: “......Yes.”
Nurse:”Thanks, just wanted to check.”

I've had this exact situation arise a few times with a nurse who is nervous, not confident, or just not mentally fit to take care of patient who is that sick which results in numerous pages for non critical issues. I usually take it as a sign that we need to loop in some senior nurses to supervise them a little better. So in those cases I usually ask to speak to the charge nurse and tell them whats been going on. That usually gets the situation sorted out in as benign a way as is possible.

 

[WinslowPringle]

About time this thread got updated...

(Of course it's a midnight page, 30 minutes after I've finally fallen asleep)
Nurse: "Hello, yes, I was just paging to see if I should hold Mr. Toothy's heparin. He's going to surgery with dental tomorrow."
Me: "What time is surgery and when is the dose of heparin you want to hold?"
Nurse: "I don't know what time surgery is. The heparin dose is at 1000."
Me: "So, this isn't about a heparin dose tonight?"
Nurse: "No. The heparin is for tomorrow."
Me: "Can I....can I ask why you're paging me about it now, at midnight?"
Nurse: "I thought you'd be easier to reach tonight instead of tomorrow during rounds."
Me:..........."Ok. Please hold the 1000 heparin."
Nurse: "Can you put it in?"
Me: ............"No."

///////

Text page: "Hello, wanted to notify you Mr. Micturia urinated in toilet not in hat. UOP recorded as x1. Amt not recorded."
(Midnight page, not on a pt we were monitoring for beyond the normal I/Os. Nurse really just wanted to notify pt wasn't voiding in urinal or the hat.)

 

[sunshinefl]

About time this thread got updated...

(Of course it's a midnight page, 30 minutes after I've finally fallen asleep)
Nurse: "Hello, yes, I was just paging to see if I should hold Mr. Toothy's heparin. He's going to surgery with dental tomorrow."
Me: "What time is surgery and when is the dose of heparin you want to hold?"
Nurse: "I don't know what time surgery is. The heparin dose is at 1000."
Me: "So, this isn't about a heparin dose tonight?"
Nurse: "No. The heparin is for tomorrow."
Me: "Can I....can I ask why you're paging me about it now, at midnight?"
Nurse: "I thought you'd be easier to reach tonight instead of tomorrow during rounds."
Me:..........."Ok. Please hold the 1000 heparin."
Nurse: "Can you put it in?"
Me: ............"No."

///////

Text page: "Hello, wanted to notify you Mr. Micturia urinated in toilet not in hat. UOP recorded as x1. Amt not recorded."
(Midnight page, not on a pt we were monitoring for beyond the normal I/Os. Nurse really just wanted to notify pt wasn't voiding in urinal or the hat.)

those are both so unreasonable

 

[PTPuser]

About time this thread got updated...

(Of course it's a midnight page, 30 minutes after I've finally fallen asleep)
Nurse: "Hello, yes, I was just paging to see if I should hold Mr. Toothy's heparin. He's going to surgery with dental tomorrow."
Me: "What time is surgery and when is the dose of heparin you want to hold?"
Nurse: "I don't know what time surgery is. The heparin dose is at 1000."
Me: "So, this isn't about a heparin dose tonight?"
Nurse: "No. The heparin is for tomorrow."
Me: "Can I....can I ask why you're paging me about it now, at midnight?"
Nurse: "I thought you'd be easier to reach tonight instead of tomorrow during rounds."
Me:..........."Ok. Please hold the 1000 heparin."
Nurse: "Can you put it in?"
Me: ............"No."

///////

Text page: "Hello, wanted to notify you Mr. Micturia urinated in toilet not in hat. UOP recorded as x1. Amt not recorded."
(Midnight page, not on a pt we were monitoring for beyond the normal I/Os. Nurse really just wanted to notify pt wasn't voiding in urinal or the hat.)

I was a nurse in my previous life. I would've gotten smacked so hard from the attending with ringing ears if I tried this ****.

 

[Lem0nz]

I’m going to put in a reverse plug for my SICU nurses who were some of my best friends in residency.
Me: “Hey guys, everyone’s tucked in and it’s really slow; the team and I are going to go watch Dr. Strange and then I think I’m going to go to sleep. Does anyone care?”
SICU: “Nah, we won’t bother you. Want to get in on this Chinese order?”
Me: “Absolutely.”

They only paged that night to let me know my sesame chicken was there.

Had that entire night shift over for BBQ at least once every other month on me for their level of amazing. We played Cards Against Humanity an entire night once too, after that ICU poker meme thing.

So, still ridiculous. But mostly because I’m a clown.

 

[Lem0nz]

Oh but for disbelief pages, did anyone else have that weird series of Alaris pump failures back around 2015-2016?

Rando Floor Nurse: "So, I don't know how to tell you this. The alaris pump broke and the patient got an entire bag of heparin."
Me: "Wait. What? The entire bag? How much is that?"
Nurse: "No idea, I'm freaking out."
Me: "Call pharmacy and tell them to make protamine right now for whatever dose of heparin comes in a standard bag and to not ask questions or hesitate."
Me, spongebob meme, six hours later doing Q15 neuro checks all. night. long. 😢

And then, a month later
Nurse: "**** doc. The alaris pump broke and the patient got an entire bag of versed."
Me: "AGAIN!?"
Nurse: "...what do you mean again?"
Me: "IS HE TUBED?!"
Nurse: "Yea."
Me: "Oh ok. We'll ride that out."
And so we did. It took that homie like five days to so much as twitch.

 

[dpmd]

I’m going to put in a reverse plug for my SICU nurses who were some of my best friends in residency.
Me: “Hey guys, everyone’s tucked in and it’s really slow; the team and I are going to go watch Dr. Strange and then I think I’m going to go to sleep. Does anyone care?”
SICU: “Nah, we won’t bother you. Want to get in on this Chinese order?”
Me: “Absolutely.”

They only paged that night to let me know my sesame chicken was there.

Had that entire night shift over for BBQ at least once every other month on me for their level of amazing. We played Cards Against Humanity an entire night once too, after that ICU poker meme thing.

So, still ridiculous. But mostly because I’m a clown.

For me it was the floor nurses in the ward where our call rooms lived. Was easy to swing by and see if anyone had any issues before I went to nap and they would always invite me to come eat dinner with them (they frequently did potluck style and were mostly Filipino so it was good food).

 

[Lem0nz]

OH! Last one, I swear. Intern year 2014.

Nurse: "So trauma patient ______ in room ______ came up an hour ago and I just noticed something weird."
Me: "Ok...?"
Nurse: "His chart says he's on contact precautions for Ebola."
Me: "He... it... what?"
Nurse: "Do you know what that means?"
Me, in the middle of the ebola scare: "What? Do you watch the news?! Listen, whatever. Has he had any recent international travel? Do we know this is real?"
Nurse: "I don't know, I'm not going in there. You're making this seem really scary."
Me: "..."
Me: "Lock down the floor. No one leaves the floor or talks to any patients or interacts with anyone until I figure this out. Put the charge nurse on the phone."

Turns out trauma registrar misclicked a button two shifts prior. The scary thing was that it took that long for them to notice. Took me three hours to track down that registrar. Intern **** man.

 

[WheezyBaby]

Plenty of silly pages but this one is by far my most memorable. Intern year at our children's hospital. Anyway, call back a page at like 0200

Me - "'y'lo this wheezy what's up"

RN - "..."

Me - "hello?"

RN - *sounds of sniffling but no words*

Me - "hey is there anyone there?"

RN - "it's..." *sniffles* "it's, ALL over the, the, WALLS!!" *sniffles, sounded like she'd been crying*

Me - "umm, what?"

RN - "there's poop EVERYWHERE"

Me - "oh, um... I'm sorry. Is there something I can help with?"

RN - despondent resigned "no..." *hangs up*

Was crosscovering a kindergarten-ish age patient who was a voluntary stool holder and hadn't pooped in like 4 weeks there with impaction. Was getting reamed from above and below but hadn't gotten much out all day. Apparently finally made some progress! I check on the RN an hour or two later and she seemed to have made a recovery

Have received a patient call to the on-call pager because they were in the ER and wanted me to speed up their wait.

Had a well established patient in the ED who's family CAME TO MY ****ING CALL ROOM to see if I could get them upstairs sooner. IT DOES NOT WORK THAT WAY MAAM

Rando Floor Nurse: "So, I don't know how to tell you this. The alaris pump broke and the patient got an entire bag of heparin."
Me: "Wait. What? The entire bag? How much is that?"
Nurse: "No idea, I'm freaking out."

Eyes bulged out just reading this would've crapped myself, that's a traumatic page. "uhhhh I'm freaking out too"

 

[LucidSplash]

Eyes bulged out just reading this would've crapped myself, that's a traumatic page. "uhhhh I'm freaking out too"

So basically like doing vascular surgery. Give some protamine, it’s cool.
Next page was probably “should we hold the baby aspirin?”

 

[WheezyBaby]

So basically like doing vascular surgery. Give some protamine, it’s cool.
Next page was probably “should we hold the baby aspirin?”

Yall are bolusing 25k U UFH in vascular? I guess at some point you're running out of atiii to target regardless

 

[ThoracicGuy]

Yall are bolusing 25k U UFH in vascular? I guess at some point you're running out of atiii to target regardless

Ready to go on pump!

 

[WheezyBaby]

Ready to go on pump!

Never realized cpb load was 300-350/kg. 4-5x what I've seen even for ecmo. TMYK!

 

[LucidSplash]

I mean I was being a little facetious.

But sometimes close to this. Depends on what we are doing and how long. but if you’re trying to get ACT >200 for like a AAA or TAAA, you give an initial amount based on weight, check the ACT and then give more if needed. And for CABG, I think the typical ACT for bypass >400. They usually start with 300u/kg bolus and then check the ACT and go from there. So like your average fat American 90kg patient is getting like 27000 off the bat.

Which is why I always roll my eyes at the phone calls I get before an Angio that ask if I want to hold the prophylactic LMWH.

Edited to add now I see @ThoracicGuy beat me to the response!

 

[Lem0nz]

Yea, I definitely didn't know any of that as a PGY2. I just gave him protamine and did neuro checks all night because I was terrified he'd have a hemorrhagic stroke.

 

[GassYous]

Yea, I definitely didn't know any of that as a PGY2. I just gave him protamine and did neuro checks all night because I was terrified he'd have a hemorrhagic stroke.

Don't blame you a bit I would freak out too

 

[Dr.LeoSpaceman]

Which is why I always roll my eyes at the phone calls I get before an Angio that ask if I want to hold the prophylactic LMWH.

"IR says they can't place the drain today because the patient got SQH this AM."

 

[longhaul3]

"IR says they can't place the drain today because the patient got SQH this AM."

"IR says they can't place the drain today because it's a day that ends in -y. Might be able to get him on the schedule for tomorrow, call back then. NPO every day at midnight for the next week just in case"

 

[LucidSplash]

"IR says they can't place the drain today because the patient got SQH this AM."

Or place the tunneled line for 5 days because of plavix. Yep.

As a chief resident, once had the IR NP chastise me for pushing for a drain placement in an ACS patient who was kinda sick because they had LMWH or ASA or something on board. His excuse was “what happens if Dr. X hits the iliac artery while the patient is on heparin?” And I just was flabbergasted and said “if you think the heparin is the problem in that situation, I’m not sure what to tell you.”

 

[deleted50541]

Or place the tunneled line for 5 days because of plavix. Yep.

As a chief resident, once had the IR NP chastise me for pushing for a drain placement in an ACS patient who was kinda sick because they had LMWH or ASA or something on board. His excuse was “what happens if Dr. X hits the iliac artery while the patient is on heparin?” And I just was flabbergasted and said “if you think the heparin is the problem in that situation, I’m not sure what to tell you.”

Of all that I learned from my CT training, it's mostly that I don't sweat about people on blood thinners and anti-platelet meds anymore.

 

[Jolie South]

Of all that I learned from my CT training, it's mostly that I don't sweat about people on blood thinners and anti-platelet meds anymore.

"IR says they can't place the drain today because it's a day that ends in -y. Might be able to get him on the schedule for tomorrow, call back then. NPO every day at midnight for the next week just in case"

Or place the tunneled line for 5 days because of plavix. Yep.

As a chief resident, once had the IR NP chastise me for pushing for a drain placement in an ACS patient who was kinda sick because they had LMWH or ASA or something on board. His excuse was “what happens if Dr. X hits the iliac artery while the patient is on heparin?” And I just was flabbergasted and said “if you think the heparin is the problem in that situation, I’m not sure what to tell you.”

SO RIDICULOUS.

I mean I had to convert a TCAR to CEA in a patient on ASA and brilinta after full heparinization. Would I want to do that every day? No. But the patient didn’t bleed to death.

 

[dpmd]

My favorite is when IR is scared of the med they are on or their labs and suggests I do it instead. Like an open procedure or even a laparoscopic procedure with blind entry is somehow safer than sticking a needle into something with image guidance.

 

[Dr.LeoSpaceman]

My favorite is when IR is scared of the med they are on or their labs and suggests I do it instead. Like an open procedure or even a laparoscopic procedure with blind entry is somehow safer than sticking a needle into something with image guidance.

This reasoning never makes sense to me for another reason. And it happens with other procedural situations across other specialties (e.g. I don't think it will work/be possible/etc.), as well. I get that people are concerned about a complication, or "failing" . But generally, the bail-out for these less invasive approaches is something that might require surgery

So how does it make sense to say "I don't want to risk having a complication that requires surgery, so you should just take them to surgery."

 

[Lem0nz]

My favorite is when IR is scared of the med they are on or their labs and suggests I do it instead. Like an open procedure or even a laparoscopic procedure with blind entry is somehow safer than sticking a needle into something with image guidance.

This.

But you do get that feeling of utter satisfaction when they agree to do it if you offer to stand next to them while they do in case something goes wrong. I'm not sure at what point humans lost feathers in their evolutionary tree, but you can visibly see the muscles that used to hold them ruffle and twitch when you say that. The indignation is fantastic.

 

[WinslowPringle]

Paged at zero-dark-thirty.
Nurse: “Yes, I was wondering - Mr Insomniac was wondering if he could walk on the stairs. But he has a heparin drip.”
Me: “What’s the question?”
Nurse: “Well, can I turn off his heparin drip so he can walk on the stairs?”
Me: “He’s on a heparin drip for his new mechanical valve, right? And his INR is sub therapeutic and the PTT just barely made it to therapeutic level with the drip on, right?”
Nurse: “Yes.”
Me: “No, I don’t think it’s a great idea to turn off his heparin drip in the middle of the night so he can go climb some stairs.”
Nurse: “Oh. Ok. Well, do you think he can take the heparin drip on the pole with him on the stairs?”
Me: “.......No. No, I don’t think the patient with the just-placed mechanical valve on the heparin drip should carry his IV pole with him up and down the stairs at midnight.”
Nurse: “Oh. Well, I just thought I’d ask.”

//
Was half tempted to tell her to take him on the stairs with the pole, but I’m pretty sure she had no intention of accompanying him on this Mt Everest endeavor. And I’m also pretty sure I’d get another page half an hour later about a fall and a stat head CT and a catastrophic head bleed.....

 

[WheezyBaby]

Paged at zero-dark-thirty.
Nurse: “Yes, I was wondering - Mr Insomniac was wondering if he could walk on the stairs. But he has a heparin drip.”
Me: “What’s the question?”
Nurse: “Well, can I turn off his heparin drip so he can walk on the stairs?”
Me: “He’s on a heparin drip for his new mechanical valve, right? And his INR is sub therapeutic and the PTT just barely made it to therapeutic level with the drip on, right?”
Nurse: “Yes.”
Me: “No, I don’t think it’s a great idea to turn off his heparin drip in the middle of the night so he can go climb some stairs.”
Nurse: “Oh. Ok. Well, do you think he can take the heparin drip on the pole with him on the stairs?”
Me: “.......No. No, I don’t think the patient with the just-placed mechanical valve on the heparin drip should carry his IV pole with him up and down the stairs at midnight.”
Nurse: “Oh. Well, I just thought I’d ask.”

//
Was half tempted to tell her to take him on the stairs with the pole, but I’m pretty sure she had no intention of accompanying him on this Mt Everest endeavor. And I’m also pretty sure I’d get another page half an hour later about a fall and a stat head CT and a catastrophic head bleed.....

so much for being an early mobility champion

 

[longhaul3]

Was half tempted to tell her to take him on the stairs with the pole, but I’m pretty sure she had no intention of accompanying him on this Mt Everest endeavor. And I’m also pretty sure I’d get another page half an hour later about a fall and a stat head CT and a catastrophic head bleed.....

Got paged at zero dark forty-five by overnight radiology resident for a 2cm acute subdural. Some nurse dropped a patient with a fresh valve on a heparin drip down a flight of stairs in the middle of the night. Said something about Mt. Everest?

Anyway took him for a stat crani, plan for trach/peg later this week.

 

[WinslowPringle]

Context: Patient has been rounded on by a physician 4x this day at this point that I knew about. (Twice by myself, once by the intern alone, and once by the attending alone.) Has been inpatient for 3 days, and I have personally examined each extremity twice daily for peripheral pulse checks. I just got home for the remainder of that day’s “home” call. Remote-logging into the antiquated system is a 30minute ordeal and this hospital doesn’t take verbal orders.
///
Nurse: “Patient is complaining of a rash on his leg. Can he get some hydrocortisone?”
Me: “What rash? When did it start?”
Nurse: “Oh, he says it’s been there for weeks. He says it’s really itchy and has been bothering him badly for days.”
Me: “Weird, he’s never mentioned this before. Had you tried reaching the (in-house) intern first?”
Nurse: “Yes, multiple pages, no response.”
Me: “I’ll see what I can do…”
I contact the intern - yes, she had gotten the page, had seen the patient yet again, he denied having a rash or itching, but she had ordered some topical cream to placate the nurse, and had talked to the nurse in person.
Call the nurse back- “So, Dr Intern says she saw the patient and talked to you. What happened?”
Nurse:”Ohhhh, she’s a doctor? I thought that was just a medical student or something. Yeah, yeah, she ordered some cream. Thanks!”
///
The kicker was that when I saw the patient the next morning, he denied having an itchy rash, there still wasn’t one on exam, and he said it was something the nurse “noticed” and that he was fine. The cream was never used.

 

[wholeheartedly]

Context: Patient has been rounded on by a physician 4x this day at this point that I knew about. (Twice by myself, once by the intern alone, and once by the attending alone.) Has been inpatient for 3 days, and I have personally examined each extremity twice daily for peripheral pulse checks. I just got home for the remainder of that day’s “home” call. Remote-logging into the antiquated system is a 30minute ordeal and this hospital doesn’t take verbal orders.
///
Nurse: “Patient is complaining of a rash on his leg. Can he get some hydrocortisone?”
Me: “What rash? When did it start?”
Nurse: “Oh, he says it’s been there for weeks. He says it’s really itchy and has been bothering him badly for days.”
Me: “Weird, he’s never mentioned this before. Had you tried reaching the (in-house) intern first?”
Nurse: “Yes, multiple pages, no response.”
Me: “I’ll see what I can do…”
I contact the intern - yes, she had gotten the page, had seen the patient yet again, he denied having a rash or itching, but she had ordered some topical cream to placate the nurse, and had talked to the nurse in person.
Call the nurse back- “So, Dr Intern says she saw the patient and talked to you. What happened?”
Nurse:”Ohhhh, she’s a doctor? I thought that was just a medical student or something. Yeah, yeah, she ordered some cream. Thanks!”
///
The kicker was that when I saw the patient the next morning, he denied having an itchy rash, there still wasn’t one on exam, and he said it was something the nurse “noticed” and that he was fine. The cream was never used.

so she lied about the rash, that the pt complained about the rash, and that no one returned her pages? wow