Tuesday, May 15, 2012

Tales from Residency: Sliding scale

During my residency, we took call from home, which meant that we weren't post-call the next day. Which meant that getting paged a lot during the night was a guarantee you were going to feel like shit and do your job crappily all day the next day.

Anyway, on one such homecall, I got a page at 2AM to let me know that a patient's blood sugar was....

wait for it...


I was so furious. "But doctor, there's no sliding scale!" First of all, if there was never a sliding scale, maybe you could have let me know about this during the DAYLIGHT HOURS. Second, probably half the overweight people in the country over age 50 have a glucose of 190 right now. At 2AM, I expect to be paged about heart attacks.

The best part is that after I told him to cover it with a mild sliding scale and spent like an hour trying to get back to sleep after the anger-induced adrenaline rush, he paged me AGAIN at 6AM. "Doctor, the patient's blood sugar is now 230."

"I told you to cover his sugars with a mild sliding scale!"

"What's a mild sliding scale?"

Our hospital had a two-page sheet that was to be used with all diabetic patients where you could circle the amount of insulin coverage you wanted (mild, moderate, severe). I explained this to the nurse and he claimed no such form existed.

Now I had worked at that hospital for three years and this was not a new form. And I'm pretty sure it's something that exists in most hospitals. So I knew the form existed. And even if it didn't, why didn't he let me know about this on the FIRST phone call when I ordered the mild sliding scale? What had he done about the sugar of 190?

I started yelling, which is something I never do. I was like, "You've been waking me up about this minor issue all night and I have to work all day today and tomorrow. This is really unbelievable."

When I finally got to the hospital, I reached into the drawer of forms, got out the insulin sliding scale form (which took me about five seconds to find), and SLAMMED it down in front of the nurse. Not my finest moment, but I feel I was provoked.


  1. SomewhereI have a whiners form you can hand out..(it was made to look like a government form) but I bet you could alter it...I fill it out for the kids when they are being unreasonable.

  2. And this is why I find that, sometimes, nurses just don't think. I swear. Most of them are absolutely great; others - not so much.

  3. Speaking as a Nurse, you shoulda kicked that Nurse's ass!

  4. I am now even more excited now to start my Pathology residency in July.

  5. I NEVER have moments like that. NEVER!
    Now about that bridge I have for sale...

  6. Okay I just read that whole post imagining you as Dr Cox. Maybe you should learn to make long rants with funny cutaways and variations on the theme of "you are a girl so I'm going to call you a girl's name". Think it'd work out quite well for you.

  7. It's a good thing you didn't go into customer technical support. "I didn't do what you said because I didn't understand how to, but I didn't tell you I didn't understand--and now the problem is worse and I'm hysterical" is standard.

  8. One night I took call with the resident during my medicine rotation, she made the mistake of ordering a sliding scale on the patient. The nurse paged her EVERY HOUR with the BG reading and asked her how much insulin to give. She "just wanted to make sure".

  9. That's how nurses troll us.