Tuesday, March 22, 2011

Tales from Intern Year: Night Pages from Nurses, Part 2

This is a follow-up from my cartoon about Types of Night Pages from Nurses....

No offense to any nurses or future nurses because many are truly fantastic (I love all the nurses I work with now), but I've had some pages from nurses that made me almost pop an aneurysm in my brain. Seriously, you'd think when you give a verbal order, they wouldn't have to page you again later to clarify the order, cuz if there were a mistake, they should have caught it while I was saying it, right? Anyway, during one of my overnight calls as an intern, I wrote down a few choice pages:

8PM: "Doctor, Mr. L's blood pressure is now 86/55."
"Okay, what's his pulse?"
"Oh. Hold on..."
(five minutes later)
"His pulse is 100."
"And what's his O2 sat?"
"Oh. Uh, hold on again...."
(five minutes later)
"Sorry, I can't find his vitals."

10PM: "Doctor, you wrote for Mr. J to be NPO until the morning, but can you write for a diet for the morning?"
"OK, let's give him a diabetic diet in the morning."

10:15PM: "Doctor, did you want to write for a diet for Mr. J?"
"YES, I wanted to give him a diabetic diet starting the morning. I JUST talked to the charge nurse about this."

4AM: "Is this Dr. K?"
"No, I'm covering for her. What's the problem?"
"Doctor, Mr. Q had a surgery today, but Dr. K never wrote a set of new orders for after the surgery. You need to write a completely new set of orders for him."
"Well, she's out of the hospital now and I don't know the patient. Can you wait a few more hours till she comes in?"
"No. Mr. Q has been sitting here without orders for nine hours and he needs orders NOW."
"So he's been back from the surgery since 7PM yesterday and you waited until 4AM to call? Why didn't you call during the daytime hours if it was so urgent?"

5AM: "Doctor, you wrote for Mrs. N that she has no allergies, but she says she's allergic to Vicodin."

5:20AM: "Doctor, I called you just before about Mrs. N being allergic to Vicodin, but she's actually allergic to Lithium, not Vicodin."
(As if they were about to administer a dose of Lithium to her imminently and only waking me up at 5 in the morning to tell me she was allergic would be able to stop this from happening. FYI, I didn't write to give her lithium OR vicodin.)

After the nonstop pages finally stopped, I managed to fall sleep. Except I fell asleep on top of my phone, which contains the alarm that wakes me up. So I ended up waking up half an hour later than I intended. I woke up to a page from a nurse, who was trying to get in touch with my co-intern. I still had my co-intern's pager from last night, even though she was in the hospital. (I have no idea why she didn't try to get it back from me. It's not like I was difficult to reach with TWO pagers. I'm guessing she didn't want it back.)

I did the quickest rounds in history. I checked labs super-fast, got all the vitals, then I basically just peeked my head into each patient's room to make sure they weren't dead. Somehow I finished with one minute to spare. I used that minute to pee for the first time that entire morning. What a luxury.


  1. I think the first page should have been either "he is comfortably asleep", or "He seems to be in distress and can't catch his breath". If a nurse is paging you with abnormal vital signs those other things are kinda important.
    I actually asked my mom about the 1am calls for constipation. She said that when the night nurses get settled, they go through the patient's chart and start housekeeping. It didn't tell me how to fix it, but it kept me from thinking that the nursing staff had a conspiracy to torture me; it just means that was the time they finally were able to sit down and start paperwork.

  2. during residency, how much free time outside of work were you able to have? i know its going to be superrr frantic and chaotic for 4 years or so.

    anyhow, i absolutely enjoy your cartoons integrated into your blogs -- definitely provides valuable insight (and comedic relief). keep up the awesome work!

  3. OK, I can thankfully say I never EVER get pages like the last one. I actually don't mind most pages. I do mind when I have to track down nurses to do things like, say, draw cardiac enzymes that should have been drawn hours ago.

    I remember one [traveling] nurse defended, "Well, he's a really hard stick," and "Besides, I've been really busy all night." We had a little talk about the implications of delaying MI diagnosis & treatment. Then I drew blood from his fucking EJ line which took all of 1 minute.

  4. Meh, that first call could have been me the first time I ever called a doctor to get orders. Our nursing school harped a lot on good doctor-nurse communication but never applied it in any practical manner. I think I almost peed my pants the first time I actually had to call a doc on my own about a patient.

  5. manixter: I've gotten dozens of pages that were very obviously the result of the nurses getting bored and flipping through the charts to do housekeeping at 2AM.

    blurredtime: This is entirely dependent on the type of residency and your specific program.

    PGYx: I had a nurse pressure me to take the patient off a telemetry bed. I asked her what the second set of cardiac enzymes were. She never drew them... then defended it by saying they wouldn't be back yet anyway. They don't come back any faster if you never draw them!

  6. Lol I can't wait for my internship...