Overnight pages - memorable/dismal/ridiculous/unique

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In the vein of one of my all-time favorite threads, the ridiculous consult thread, I thought I'd start a similar one for those of us plagued by being awoken by dumb pages for which the tempting response 90% of the time is "MD aware".

A couple recent highlights off the top of my head:
"Patient's temperature [POD1] is 99.6. Her room is really hot though so I turned down the heat and gave her Tylenol. I thought you should know."

"Patient [who had abdominal surgery] is asking to shave his beard. Is that OK?"
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Awful call
everyone is febrile, did 20 cultures
2 am
finally put my head down

"Patient is tachycardic"
heart rate 102
Admitted 2 days ago to tele unit for sinus tachy
team is going up on beta blocker
heart rate has been improving

patient sleeping soundly
 
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As I'm now taking calls from patients on the answering service, these are even worse.

Friday Night
(Woman regarding her father who has colostomy)
Woman: He hasn't had much out in about a day, and he's feeling a bit "full".
Me: Any new nausea/vomiting/pain/skin redness around stoma?
Woman: No.
Me: Why don't you have him try some Miralax tonight and tomorrow morning. If this doesn't work, call me back.

(The conversation was actually much more exasperating, as it was actually like 15 minutes of explaining stool softeners, and how some people use them daily or titrate to effect. I was wondering how an "old person" didn't understand the concept of stool softeners.)

Sunday Night
Woman: So just calling back because we used the miralax, and he had output all day Saturday, but now there's nothing again. Shouldn't we come into the ED?
Me: Did you try the Miralax again?
Woman: Oh. You mean we can do that?
Me (after shoving an ice pick in my eye): Yes. Don't you remember we discussed how some people need to use them as needed?
Woman: Oh, now I do. Great!
 
Always at midnight:

Can you please chart the patients statin.
 
[Female nurse, calling regarding female patient, both in their late 20s. Female patient came in as a trauma, is on the floor, and has been completely stable for a few days. It's 2am. The page is marked 'Urgent.'] "Yes, I just wanted to notify you the patient is bleeding.'

[Male resident, younger than both nurse and patient]. "Ok, tell me what's going on. What's her heart rate, blood pressure?"

Nurse: "Stable, within normal limits."
Resident: "Ok. What's going on? Where is she bleeding?"
Nurse: "I saw it. She's bleeding from her vagina."
Resident: "....She's bleeding from her vagina...?"
Nurse: "Yes. Do you think it's related to the trauma?"
Resident: "Well, uh, did the patient say anything?"
Nurse: "Yes, she thinks she's on her period."
Resident: "She thinks she's on her period?....Is she bleeding heavily?"
Nurse: "No. I guess it looks kinda like menstrual blood."
Resident: "Ok. Thank you for notifying me. I think the patient's probably right. We'll assess her on morning rounds. Thanks."

Dead serious. Wish I could be making this up.
 
WinslowPringle said:
[Female nurse, calling regarding female patient, both in their late 20s. Female patient came in as a trauma, is on the floor, and has been completely stable for a few days. It's 2am. The page is marked 'Urgent.'] "Yes, I just wanted to notify you the patient is bleeding.'

[Male resident, younger than both nurse and patient]. "Ok, tell me what's going on. What's her heart rate, blood pressure?"

Nurse: "Stable, within normal limits."
Resident: "Ok. What's going on? Where is she bleeding?"
Nurse: "I saw it. She's bleeding from her vagina."
Resident: "....She's bleeding from her vagina...?"
Nurse: "Yes. Do you think it's related to the trauma?"
Resident: "Well, uh, did the patient say anything?"
Nurse: "Yes, she thinks she's on her period."
Resident: "She thinks she's on her period?....Is she bleeding heavily?"
Nurse: "No. I guess it looks kinda like menstrual blood."
Resident: "Ok. Thank you for notifying me. I think the patient's probably right. We'll assess her on morning rounds. Thanks."

Dead serious. Wish I could be making this up.
Click to expand...
Oh, I know you're not making it up. I have literally gotten this same call.

Common pages I get related to bleeding:
"Patient is bleeding out from wound, bandages are soaked, come look now!"
-On arrival, scant blood on dressing only mildly increased from previous exam

"Patient is bleeding out from site of line removal/HD access/etc, omg"
me "has anyone attempted holding pressure?"
Response is usually no. When I get there, there's still typically no one holding pressure. However it's fine because the bleeding is usually just a slow trickle or resolved by the time I get there.
 
Midnight page from inpatient floor nurse:

“Patient being dc’d in AM and parents concerned that their pharmacy may not carry liquid oxy. Please advise.”

Called back using my kindest, slowest, most deliberate midnight voice:
“What pharmacy do they use?”
-hold on....cvs on main
“Ok. Let’s see if we can find some other options. Can you ask them what other pharmacies are near their home?”
-ok hold on....(hold music)....ok they said there’s a Walmart and a Walgreens nearby too
“Ok that’s good. I’m away from the computer at the moment; can you google those pharmacies and confirm the addresses with the parents?”
—uh sure, hold on....(more hold music)...ok I’ve got them pulled up
“Great! Can you give me the phone numbers so I can call them and check on that med?”
—-uhhhhh surrrre, but...don’t you think they’ll all be closed at this time of night?
“Yes. Yes I do”
—-oh s—t I’m sorry I totally shouldn’t have paged you about this right now!

If you give a man a fish....
 
doyouhaveaflag said:
Oh, I know you're not making it up. I have literally gotten this same call.

Common pages I get related to bleeding:
"Patient is bleeding out from wound, bandages are soaked, come look now!"
-On arrival, scant blood on dressing only mildly increased from previous exam

"Patient is bleeding out from site of line removal/HD access/etc, omg"
me "has anyone attempted holding pressure?"
Response is usually no. When I get there, there's still typically no one holding pressure. However it's fine because the bleeding is usually just a slow trickle or resolved by the time I get there.
Click to expand...

The problem is you call back and ask if someone has held pressure and you'll get, we've held pressure for 15 minutes and it doesn't stop. And typically what has happened is someone has held pressure for 30 seconds... checked for bleeding, still bleeding, held pressure for 30 seconds... checked of bleeding... oh still bleeding, hold pressure for 30 seconds... etc. etc. for 15 minutes.
 
metzthatcut said:
The problem is you call back and ask if someone has held pressure and you'll get, we've held pressure for 15 minutes and it doesn't stop. And typically what has happened is someone has held pressure for 30 seconds... checked for bleeding, still bleeding, held pressure for 30 seconds... checked of bleeding... oh still bleeding, hold pressure for 30 seconds... etc. etc. for 15 minutes.
Click to expand...

Don't worry, there will be a variety of IV bags, dressing supplies, sand bags, and room furniture strategically placed over the bleeder as well.
 
metzthatcut said:
And typically what has happened is someone has held pressure for 30 seconds... checked for bleeding, still bleeding, held pressure for 30 seconds... checked of bleeding... oh still bleeding, hold pressure for 30 seconds... etc. etc. for 15 minutes.
Click to expand...

Yeah, I also call this the primary care nosebleed protocol.
"It just won't stop doc!"
"What do you do to stop it?"
"I press here for a minute, and it seems like that works, but then I blow my nose and it just starts over again!"

Of course, I don't necessarily expect the patient to understand that clotting takes time.
 
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I don't get a ton of middle-of-the-night nursing pages anymore (thank god), but my favorites from residency were always:

3am "Patient has requested colace."

Really? The patient woke up at 3am and asked for a colace order? More importantly, that couldn't wait?

or

3am Patient states post abdominal surgery the day prior. Hasn't had a bowel movement. Requesting Colace. at 3am. for a post-op patient with no BM.

or

Random 3am page from nursing because they were "cleaning up his orders" when they noticed his diet order is set to expire in two days and they were hoping you could fix that.

I actually got a call once from a pharmacist after hours because I had written an order for floxin otic. A topical antibiotic drop. She was concerned because I had written for 5 drops, and her guidebook said 4 drops.
 
FaytlND said:
Don't worry, there will be a variety of IV bags, dressing supplies, sand bags, and room furniture strategically placed over the bleeder as well.
Click to expand...

Those damn sand bags over anything that was bleeding "emergently" was the bane of my existence intern year. "All it takes to stop most bleeds is one well-placed finger" was advice I wish was more mainstream.
 
I thankfully don’t get pages anymore but during residency, we got a page about our trauma patient who was a pimp. One of his girls came in to “service” him, and when the patient’s roommate complained and security came, the girl refused to leave. Two guards had to wrestle her off the guy, as she was screaming and trying to scratch them, and throw her out of the hospital.
Yes, I did my residency at an interesting inner city place, ahem ahem....


Sent from my iPhone using SDN mobile
 
OrthoTraumaMD said:
I thankfully don’t get pages anymore but during residency, we got a page about our trauma patient who was a pimp. One of his girls came in to “service” him, and when the patient’s roommate complained and security came, the girl refused to leave. Two guards had to wrestle her off the guy, as she was screaming and trying to scratch them, and throw her out of the hospital.
Yes, I did my residency at an interesting inner city place, ahem ahem....


Sent from my iPhone using SDN mobile
Click to expand...

Did she at least have his money?
 
Once got a call early morning when I would otherwise have been able to sleep like an hour more before going to round. On a peds patient who had an order to call if uop less than 30 ml/kg (I won't get into whether this was a good order for someone to have placed or not). They calculated it as 29.5 ml/kg instead for that particular moment in time that was not the end of their shift or any other logical period that i could fathom at that particular hour. Just so happened that my husband could hear what the nurse said, so while I am trying to take formulate how to tell this nurse that think this is something that could wait for rounds for us to address he loudly calls out for me to have the nurse squeeze the kid to see if they can get that last half an ml per kilo out of them. Had to get off the phone quickly so they wouldn't hear me cracking up at that.
 
HighPriest said:
I actually got a call once from a pharmacist after hours because I had written an order for floxin otic. A topical antibiotic drop. She was concerned because I had written for 5 drops, and her guidebook said 4 drops.
Click to expand...

Thank goodness she called. We all know that one extra drop will cause the patient's head to explode. I used to have a M.A. in my office who got a little careless with the ear drops. We had to fire her because all the exploding heads were bad for business. And the janitor hated us...
 
OtoHNS said:
Thank goodness she called. We all know that one extra drop will cause the patient's head to explode. I used to have a M.A. in my office who got a little careless with the ear drops. We had to fire her because all the exploding heads were bad for business. And the janitor hated us...
Click to expand...
It was a close call, and I put forth some cash out-of-pocket for a full page add in the local rag to celebrate her attentiveness.

This was one of the few calls where I had to drop my game face. My response was "are you serious?" Followed by long pause and then "ehm...yes?" And then my telling her it should be fine. It wasn't a satisfying conversation.
 
OrthoTraumaMD said:
I thankfully don’t get pages anymore but during residency, we got a page about our trauma patient who was a pimp. One of his girls came in to “service” him, and when the patient’s roommate complained and security came, the girl refused to leave. Two guards had to wrestle her off the guy, as she was screaming and trying to scratch them, and throw her out of the hospital.
Yes, I did my residency at an interesting inner city place, ahem ahem....


Sent from my iPhone using SDN mobile
Click to expand...

That's a keeper
 
dpmd said:
Once got a call early morning when I would otherwise have been able to sleep like an hour more before going to round. On a peds patient who had an order to call if uop less than 30 ml/kg (I won't get into whether this was a good order for someone to have placed or not). They calculated it as 29.5 ml/kg instead for that particular moment in time that was not the end of their shift or any other logical period that i could fathom at that particular hour. Just so happened that my husband could hear what the nurse said, so while I am trying to take formulate how to tell this nurse that think this is something that could wait for rounds for us to address he loudly calls out for me to have the nurse squeeze the kid to see if they can get that last half an ml per kilo out of them. Had to get off the phone quickly so they wouldn't hear me cracking up at that.
Click to expand...

I couldn't get too mad about that because at least they were following the order. I had a 2am page once and the nurse tells me the pts temperature was 37.9 and then 38.0....and before I can even say anything the nurse says, "...and I know the order says to call house office if temp is >38.4, but I thought you would want to know it's getting close...."
 
One night, sick from an URI, when I had just laid down at 3 AM to hopefully get an hour or so of sleep in before rounds and before having to run between hospitals again, I got paged by an chirpy IM intern.
Her: "Not about any patient in particular, but why do you order steroids for swelling from tumors and not strokes?"
Me: "Why is this something that you need to ask at this hour?"
Her: "Oh, cause I thought that you'd be awake, too."

I can't remember what I said, but it may have been something about googling vasogenic vs. cytotoxic edema...and I know I probably sounded pretty grumpy and near death
 
Another I just remembered...I was cross-covering the peds hospital and someone had ordered an enema earlier that day. At 1 AM a very young RN called me to ask "How much enema should I give?" I looked in the computer, and found an order that said, "Soap suds enema: One."

I ask, "How much do you normally give?"
Her: "I don't know."
Me: "Isn't there a charge nurse (the seasoned ones at this hospital were still in their twenties) you can ask who is there with you?"
Her: "Well, isn't there an attending there with you who you can ask?" (I laugh to myself, as our attendings are not in house, and were pretty useless with any kind of nursing or pharmacy issue--their eyes would literally glaze over)
Me: "My mom is a nurse. Do you want me to call and ask her?"
Her: "Nevermind; I'll ask my charge nurse."
 
kitsunepixie said:
Another I just remembered...I was cross-covering the peds hospital and someone had ordered an enema earlier that day. At 1 AM a very young RN called me to ask "How much enema should I give?" I looked in the computer, and found an order that said, "Soap suds enema: One."

I ask, "How much do you normally give?"
Her: "I don't know."
Me: "Isn't there a charge nurse (the seasoned ones at this hospital were still in their twenties) you can ask who is there with you?"
Her: "Well, isn't there an attending there with you who you can ask?" (I laugh to myself, as our attendings are not in house, and were pretty useless with any kind of nursing or pharmacy issue--their eyes would literally glaze over)
Me: "My mom is a nurse. Do you want me to call and ask her?"
Her: "Nevermind; I'll ask my charge nurse."
Click to expand...
For anyone else who may need this info, the little packet of soap that comes with the kit gives a fluid range for diluting it in. As for how much to run into the patient... I would think you just go until they say stop or start leaking out more than they put in.
 
Had this one a few months ago:

Phone rings at 2 AM. I’m sound asleep (not used to getting called in the middle of the night as a podiatrist).
Me: (Super groggy) Hello?
Nurse: Hi, this is Mary, one of the nurses on inpatient rehab. I’m locked out.
Me: ... Umm, what?
Nurse: I’m locked out.
Me: Locked out of what?
Nurse: My computer.
Me: Umm, ok...
Nurse: Isn’t this IT?
Me: No. this is Dr. ldsrmdude.
Nurse: Oh... (hangs up)

No apology, just click. I have no idea how she got my number or why she thought I was IT.
 
Not an overnight page but...
Get a page from pharmacy.

Pharmacy: “I see you dc’d the vanc and the pharmacy consult for vanc. Do you still want vanc?

Me: “Umm no. I thought that was clear from dc’ing the order for the med and the consult. My note also says so.”

YOU CAN’T WIN
 
Jolie South said:
Not an overnight page but...
Get a page from pharmacy.

Pharmacy: “I see you dc’d the vanc and the pharmacy consult for vanc. Do you still want vanc?

Me: “Umm no. I thought that was clear from dc’ing the order for the med and the consult. My note also says so.”

YOU CAN’T WIN
Click to expand...

LOL. Love these. Got a call last month at like 1am from pharmacy...

“There was an order for weight-based heparin gtt but that was cancelled and now there’s an order for non-protocol heparin and TPA at the same time. Do you want me to cancel that and restart the weight-based heparin gtt.”

Me: “Huh? I personally cancelled the weight-based gtt and wrote for heparin at 500u/hr this afternoon when we started the patient on chemical thrombolysis. The order is correct, leave it alone.”

Pharmacy: “What, you can’t run heparin and TPA at the same time, that’s dangerous!”

Me: [groggy, wondering WTF we are doing having a convo like this hours after the orders were written]: “Actually we always run heparin through the sheath at 500 when we run TPA through a catheter. This is completely normal.”

Pharmacy: “I’m not comfortable with this, I will need to call my supervisor. I think you should hold everything while I check on this.”

Me: “No, the lysis continues as written. You call your supervisor. In the meantime the order stands. I’m going back to sleep.”

Incidentally, no call back after she spoke with her supervisor.
 
operaman said:
Midnight page from inpatient floor nurse:

“Patient being dc’d in AM and parents concerned that their pharmacy may not carry liquid oxy. Please advise.”

Called back using my kindest, slowest, most deliberate midnight voice:
“What pharmacy do they use?”
-hold on....cvs on main
“Ok. Let’s see if we can find some other options. Can you ask them what other pharmacies are near their home?”
-ok hold on....(hold music)....ok they said there’s a Walmart and a Walgreens nearby too
“Ok that’s good. I’m away from the computer at the moment; can you google those pharmacies and confirm the addresses with the parents?”
—uh sure, hold on....(more hold music)...ok I’ve got them pulled up
“Great! Can you give me the phone numbers so I can call them and check on that med?”
—-uhhhhh surrrre, but...don’t you think they’ll all be closed at this time of night?
“Yes. Yes I do”
—-oh s—t I’m sorry I totally shouldn’t have paged you about this right now!

If you give a man a fish....
Click to expand...
This is expertly handled btw, not being sarcastic well done
 
4 AM text page asking if I want AM labs on a patient. No callback number given.
I track down the nurse and inform her I ordered the labs 16 hours ago when I admitted the patient from PACU.
She has somehow admitted the patient and been caring for them for her entire shift with no orders because she did not release the orders I placed.
 
swoopyswoop said:
4 AM text page asking if I want AM labs on a patient. No callback number given.
I track down the nurse and inform her I ordered the labs 16 hours ago when I admitted the patient from PACU.
She has somehow admitted the patient and been caring for them for her entire shift with no orders because she did not release the orders I placed.
Click to expand...

Better than: 4am page that we're maxed on levo and do you want to add vaso?
What levo? Oh, the levo the anesthesiology resident started in PACU after you had post-op seen your patient and no one told you about before he was dismissed to the ICU. That levo. Ok, cool.
 
Not a page but anesthesia during a case:

Anesthesia: This patient is real sweet
Me: um what
Anesthesia: her sugar is 300
Me: ok, so insulin?

1 hour later
Anesthesia: wow, she is just too sweet
Me: okkaaaaayyy

While transporting the patient to PACU
Anesthesia: You know you may want to do something about this. She is real sweet.
Me: :/ you mean like insulin? *what in the actual efffffff*
 
WinslowPringle said:
Better than: 4am page that we're maxed on levo and do you want to add vaso?
What levo? Oh, the levo the anesthesiology resident started in PACU after you had post-op seen your patient and no one told you about before he was dismissed to the ICU. That levo. Ok, cool.
Click to expand...
Or the contrary. “Yea so your carotid arrived maxed on nitroglycerin”.

Umm what?

“Yea pressure is 180. Patient didn’t take any of their 4 home meds before surgery.”

So could we start the home meds then?
 
After calling the day shift nurse and explaining why I was making a patient NPO (pancreatitis and severe abdominal pain), 2 am page from night shift nurse "I was just wondering what the reason is for being NPO???"

3 AM page from a charge nurse who was extremely concerned my patient who was satting 98% on room air and making tons of urine was in need of emergent dialysis overnight for fluid overload.
 
One of our hospitals has a main campus where we take in-house call and a really small offshoot campus, which we don't cover when in house at the Mothership. Rooms at Mothership are numbered by a five digit number. Rooms at the Offshoot are given a three digit number.

0100 and I'm woken from a deep coma: "Hello, there is a new admit for you in Room 322. Name is Y....."
Me: "Ok, I'll be right down."
Go to computer to put Pt on list, review labs/images, can't find her. Usually it means nursing hasn't notified admissions and they aren't assigned so I can't do orders. Call back.
"Sorry, I can't find the patient at all. Has she been admitted?"
Nurse:"Oh yes. It's Y....in 322."
Me:"Ok, thanks". Retype name, still nothing. Epiphany dawns, and I'm hopeful I'm not getting the admit....Call back. "Sorry, you said room 322?"
Nurse:"Yes"
Me:"That's a three digit number - is this at Offshoot?"
Nurse:"Noooo, this is at Mothership. Name is Y...., in 322."
Me."Ok."
Stare at screen and type in every combo of the name and room number I can. No luck. Call back: "So, the patient in 322..."
Nurse interrupts. "You know, you keep saying 322. It's 47-322. Building 4, Pavilion 7..."
Me: ....."K."
Find the patient...and to top it off, the name isn't Y..., it's I....
 
WinslowPringle said:
One of our hospitals has a main campus where we take in-house call and a really small offshoot campus, which we don't cover when in house at the Mothership. Rooms at Mothership are numbered by a five digit number. Rooms at the Offshoot are given a three digit number.

0100 and I'm woken from a deep coma: "Hello, there is a new admit for you in Room 322. Name is Y....."
Me: "Ok, I'll be right down."
Go to computer to put Pt on list, review labs/images, can't find her. Usually it means nursing hasn't notified admissions and they aren't assigned so I can't do orders. Call back.
"Sorry, I can't find the patient at all. Has she been admitted?"
Nurse:"Oh yes. It's Y....in 322."
Me:"Ok, thanks". Retype name, still nothing. Epiphany dawns, and I'm hopeful I'm not getting the admit....Call back. "Sorry, you said room 322?"
Nurse:"Yes"
Me:"That's a three digit number - is this at Offshoot?"
Nurse:"Noooo, this is at Mothership. Name is Y...., in 322."
Me."Ok."
Stare at screen and type in every combo of the name and room number I can. No luck. Call back: "So, the patient in 322..."
Nurse interrupts. "You know, you keep saying 322. It's 47-322. Building 4, Pavilion 7..."
Me: ....."K."
Find the patient...and to top it off, the name isn't Y..., it's I....
Click to expand...

Strong. I got paged a couple weeks ago by a nurse for the rapid response team. She paged me directly instead of going through the normal system. I call back and I immediately start hearing “you need to come see this patient in room 6 right now. He’s sick! Are you on your way???????”

Ummmmm....lady, I don’t know who are you, where are you, who is the patient, what is wrong with the patient......you gotta give me something.

Edited for a typo.
 
Last edited by a moderator:
Inget pages fairly regularly about patient POD 0 Total knee replacement with a fever of 100. Ok thanks!

Guess it’s better to get those pages myself than for them to go to the hospitalist (which at my hospital they do after 8pm). Then they get the fever workup. And hospitals wonder why total joints are going outpatient.
 
VincentAdultman said:
Inget pages fairly regularly about patient POD 0 Total knee replacement with a fever of 100. Ok thanks!

Guess it’s better to get those pages myself than for them to go to the hospitalist (which at my hospital they do after 8pm). Then they get the fever workup. And hospitals wonder why total joints are going outpatient.
Click to expand...

I had a similar one recently, day two ankle fracture with fever and clear withdrawal symptoms. White count stone cold normal. Hospitalist ordered a pan CT scan of everything: chest abdomen pelvis AND ankle, and infectious disease consult. I caught it in time, said absolutely not, took him on my service and canceled everything. He ended up leaving AMA to go drink. Probably better for him. Reminds me of that house of God tenet....The best thing to do is as little as possible.
 
OrthoTraumaMD said:
I had a similar one recently, day two ankle fracture with fever and clear withdrawal symptoms. White count stone cold normal. Hospitalist ordered a pan CT scan of everything: chest abdomen pelvis AND ankle, and infectious disease consult. I caught it in time, said absolutely not, took him on my service and canceled everything. He ended up leaving AMA to go drink. Probably better for him. Reminds me of that house of God tenet....The best thing to do is as little as possible.
Click to expand...
I miss being able to let my alcoholics drink while in house.
 
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