Tuesday, April 08, 2008

Pages From The Dark Side

There are many reasons why I have disappeared (see below for a more serious account). Yes, there are many. I could go on and on (and on and on) listing all these reasons, a diatribe on intern year...but I feel like that's been done before (see House of God), and I'd hate to shamelessly rehash material that has already been discussed ad nauseum. After 9 months of some of the hardest work I have every done, often under utterly absurd circumstances one could only describe as Kafka-esque, I have emerged. In other words, the last nine months have been a total shit show, and I've been just too freaking tired to do anything other than work, eat, poop, and occassionaly sleep. So, umm, sorry?

But with clarifications in mind, I thought I'd touch on one of the biggest parts of my intern life: my pager. Back in medical school (about 86 years ago, or so it seems), I touched briefly on the fears I had about receiving my first pager, even then sensing that something rotten lurked underneath that plastic shell. Two years later, wrought with many a prank page from the likes of Dr. Jablomie (first name Haywood) and Dr. P. Tang, I actually developed a soft spot for my pager as a form of divisive medical student entertainment. After all, when you are a medical student with zero responsibilities and a lot of free time to screw around with an electronic toy that all your friends are also carrying, life is good.

But then this year happened.

Like the cigarettes and lighter rammed up one of my more memorable patient's rectum (I’ll let you decide if I mean that the patient himself was memorable or that it was the unique qualities of his rectum that emblazoned themselves in my brain - I already know you're going with the latter), I have been subject to what amounts to a pounding of putrid pages that would make the most sane of men crack. (Was the "rectum" and "crack" in the same sentence shtick too much? It's been so long, I have a lot of things to flush out of my system...OK OK, I'll stop. Woo!) So, naturally, I would like to celebrate the best pages of the year, and what better way to do so than to hand out all sorts of awards that make no sense.

(By the way, what follows in no way suggests that we interns don’t contribute our fair share of complete incompetence that royally pisses off our nursing and pharmacy colleagues, because we do all sorts of stupid things that make their lives hell, things that I am sure I will touch upon in the near future. So I hope I do not offend anyone, specifically health care personnel or people easily offended by poop jokes - of which I predict there will be many - as it has already been established that the intern is the lowest form of scum known to man.)

Outstanding achievement in complete horseshit goes to…the 3 AM poop special
Picture it: It’s 3:00 AM. You have been working since 7 AM the day before, tirelessly, sometimes helplessly. You have finally finished up all your work and are just about to crawl into the stinky, steaming call room for a glorious 2 hours of sleep before you have to run around like a madman seeing all your patients before morning rounds. You lie down, close your eyes, start to dream about – ah shit, your pager just when off. You call back and are greeted by a cheery night-shift nurse, who poses the following question regarding one of your long-term players:
“Umm doctor? Patient _____ has not had a bowel movement on my shift and needs more meds for constipation now.”
Seriously? I mean, seriously? You’ve got to be kidding me. After nine months gentle restraint, I’m letting it all out right here, right now: PEOPLE DO NOT CRAP AT 3 IN THE MORNING, SO STOP PAGING ME ABOUT THIS!
Wow. I feel much better. Actually no I don’t. But I just cannot fathom why any rational human being would be compelled to think the middle of the night is the time to evaluate whether someone needs to drop a deuce. If anything, you’d think it would be more page-worthy to inform me if someone was dropping the kids off at 3 AM, because I’d want to start eating whatever they are eating as I bet it’d make me feel a lot better.

Best unintelligible performance goes to…*239
This page beat out some of the other contenders (namely, 33011053 and 2) for reminding me that people generally aren’t just stupid, they are also stupidly persistent. Imagine you’re me (sorry!) for a moment and you get a page that reads “*239”. Knowing that your hospital functions on 5 digit extensions and that your pager functions on 4 digit extensions, you disregard this page as an error on the hands of the person that pages you. Except 2 minutes later you get another page that reads “*239”. And then another. And another. And then you start getting paranoid, wondering which one of your patients is coding without you knowing about it, all while getting another three pages that reads exactly the same as the first. It isn’t until two hours later that, while walking down the hall, you run into the cardiology fellow, who cusses you out in front if your peers for not returning the five pages she sent you. It is also about that time that you realize your life sucks. Ladies and gentlemen, intern year!

Outstanding effort in existentialism goes to…the insulin form pages.
What follows is a roughly verbatim transcription of a telephone conversation I had with a nurse at around 3 A.M. regarding a two page insulin form (one page for when a patient is eating, another for when not eating) at my hospital:
Me (sleepy): “Hello?”
Nurse: “Umm doctor? Can you please come up and clarify insulin form?”
Me: “Now? Seriously? What’s wrong with it?”
Nurse: “The two pages have different times at the bottom.”
Me: “Well ya, because you made me fill out the second page 3 hours after I filled out the first even though the patient never actually needed the second page in the first place.”
Nurse: “Yes well they have to be timed at the same time.”
Me: “Why?”
Nurse: “Because otherwise they do not match up.”
Me: “What does that mean?”
Nurse: “They do not exist unless they match up.”
[I should remind you that we had this conversation on hour 22 of my 30 hour shift]
Me: “What does that mean?”
Nurse: “What do you mean?”
Me: “How can it not exist, I filled it out with my pen!”
Nurse: “It cannot exist if it is not filled at the same time.”
Me: “So nothing exists unless it occurs at the same time?”
Nurse: "What?"
Me: "You're telling me that these forms don't exist, that my writing doesn't count, unless they exist at the same time right?"
Nurse: "Right, they don't exist because they are timed differently."
Me: "So if they don't exist, I never filled them out in the first place. How could you be calling me about something that I never did?"
Nurse: “I don’t understand – you come fill out form now OK? Bye!”

Best attempt at unintentional comedy goes to this text page:
”Doctor, patient _____ reports that he fell out of bed last night because of the ghosts and goblins in his room. Pls call to confirm. Thx, RN”
OK maybe it’s not so funny now, but I got this page at the tail end of a 30 hour shift and it seemed like the funniest thing at the time. But I’m not sure what’s more ridiculous, what the patient told the nurse, the fact that the nurse felt like text-paging me about it, the fact that the nurse thought the information was so important he wanted me to call back just to make sure I got it, or the fact that the only thing the goblin in my room keeps telling me is that I'm paler than he is. Just making sure you are paying attention.

Outstanding achievement in clarification goes to…the All-Caps Pharmacist:
(I should remind you that these are all real pages I have received.) Yes, I would love to clarify the route for that suppository. In fact, why don’t I walk over to the inpatient pharmacy and just show you where that suppository is supposed to go, but instead of a suppository how about I use my pager instead? Hey, I’ll even set it to vibrate for you. And while I’m at it, this pharmacist must be the last person on Earth to know about that whole caps = screaming rule that everyone else learned in some shady Internet chat room with their dial-up modem 10 years ago. What's next, is this guy going to tell me to start buying my pet food on the Internet? (By the way, does anyone miss the crazy buzzing sound those things used to make when logging on? No one? OK I guess it was just me.)

Best performance in shorthand goes to…the Night-time Telemetry Tech.
At the beginning of my cardiology rotation, I started receiving all sorts of pages from one of the nighttime telemetry technicians (the folks who took at patients heart tracings and inform us if anything bad is going on) that would generally read something like “GMD, VTx3 BTS for ACS PT”. It took me weeks to figure out that “GMD” was “Good morning, Doctor”, “VT” was “ventricular tachycardia” (OK that one was kind of obvious) and “BTS” was “beats.” Well, here’s my reply: “WTF? It DM, SPMWTC”. (Loosely translates to “What the fuck? It doesn’t matter. Stop paging me with this crap.”) And by the way, it’s not a good morning if you’re paging me about something that doesn’t matter at 4 AM.

Outstanding effort in night float angst goes to…bed 14.
Night float refers to the gloriously appreciated (cough) job of the intern who has to cover all of the patients over night (except for the admitting team’s patients), which usually consists of anywhere from 50 to 70 patients on any given night. Your job is to make sure that everyone’s patients remain alive through the night, fielding pages from nurses at all corners of the hospital in rapid succession about everything from the scary (“Hi Doc, patient hasn’t been breathing for about 2 hours”) to the mundane (“Doctor, patient's blood sugar is 120, what do we do?!?!?!”). However, nothing is more maddening than this page, which I have received in various forms about 800 times this year: “Umm…doctor? Patient in bed 14 sick. Please come.”
Bed 14 eh? No name? No team? Not even a floor? Let’s think about this for a second. There are roughly 7 patient floors at my hospital, each with two wings. Each wing has a room 14, and each room has two beds. Multiply that by the stack of papers with each patient’s information, and you get 458. Why 458? Because that is the amount of hairs that fell off my head trying to figure out who the nurse was referring to.

Wow. Well, it was a really exciting year for all the winners and the nominees. I hope the winners realize how lucky they are and, more importantly, how many months they have taken off my life. I look forward to yet another year fielding next year’s candidates for the most asinine pages of the year! Now if you'll excuse me, I have about fifteen pages to return.


Anonymous Anonymous said...

I work at New York-Presbyterian, and my God I feel your pain.

11:04 PM  
Blogger S. said...

Oh no, I wanted to be first at commenting! Somebody else beat me to it. Damn it!

I'm very glad you're back, I missed your blog(s). I'm looking forward to many more interesting stories from you.

11:22 PM  
Blogger DR. 85621 said...

I'm procrastinating (as usual), and I thought to myself: "What ever happened to Fake Doctor?" and here you are! That just made my procrastinating acts worthwhile!

12:27 AM  
Anonymous Anonymous said...

I've been anticipating your return. Thank you for taking the time and energy to keep me informed of what's been happening in your life.

4:36 AM  
Anonymous Erin said...

What freakish timing. I discovered your Ah Yes, Med School blog about a week ago and have been furiously reading it at the expense of any and all work responsibilities. I just finished it today. Now you begin to blog about residency! Awesome.

I am sorry that people page you for pointless reasons. Are you especially good at maintaining your cool? It seems like you never verbally assault people, talk back to your superiors or defy authority in any measurable way. If so, you are amazing, because I feel the need to speak up whenever someone tries to bullshit me.

Will I make it through medical school?! We shall see...

Glad to see you writing again!


8:40 AM  
Blogger Dr. Wannabe said...

It's about fucking time, tard.

11:31 AM  
Blogger duo said...


11:52 AM  
Blogger Shrink Knit said...

I am glad you're back. I am sorry it has sucked like this. Please keep writing.

6:49 PM  
Blogger Doc's Girl said...

I hope that you know that as a fellow hospital secretary, it really, really angers me when people page you guys for no reason at all. Most good clerks will wait until at least 3 nurses or more need to speak to the resident on call before we send out a page but, of course, this is not the case on every floor.

You missed writing about the jerks that page, you call back immediately, but they stepped away from the desk and....pick up only after you've been calling back for about 5 minutes. When you tell them that you've been calling for a few minutes, they reply, "Oh. Whatever. Patient blah blah blah..." I felt so bad for the bf.


Nothing against nurses personally (going to school to be one here) but I wish they had a semester in school or a hospital session about paging etiquette where the nurses had to wear a pager to bed and answer to pages like you posted about.

Anyways, nice to see you back. :)

5:09 PM  
Blogger Doc's Girl said...

The bf wanted me to type this. :)

Outstanding Achievement in "Oh, You're Sleeping?" Award:

This page always tends to come when I'm on home call at approximately 2:33am. The overnight pharmacist making their nightly rounds has come across an order I wrote at 9am earlier that day.. Invariably, it is an order for a bp med that the patient will not receive until 9am the next morning. However, they page me to clarify the order. This has happened often enough that I actually snapped and had a mini tirade on a "English is definitely not my first language" pharmacist.

The gist of the conversation was me asking 1) Why are you paging me 15 hours after I wrote the order? 2) Why can't we answer this in the morning when we're actually in the hospital?

My questions are usually followed with them saying, "Oh, you're at home sleeping?"

8:50 PM  
Anonymous Anonymous said...

so, everything like "grey's anatomy" uh.. if they can do it why not u? (with the parties, sex and all that stuff!)

4:27 PM  
Anonymous Anonymous said...

SOOOOOOO happy you're back but very sad to hear about your troubles in this broken system. Maybe with the upcoming election things will improve a bit? Don't get too depressed... remember that regardless of our healthcare system, you are still doing the best you can. When it gets to be too much, take a step back and realize there are good people out there who are fighting for change! Stay well, FD!! (oops I guess it's RD)

1:24 PM  
Blogger Heidi said...

Yay you're back!! I love reading your blogs.

6:54 PM  
Anonymous Anonymous said...

Yay! you're back!

6:35 AM  
Blogger Hilary said...

Excellent post... I will definitely be back for more!

5:53 PM  
Anonymous Anonymous said...

I almost fell out of my chair laughing when I read the "Outstanding effort in existentialism goes to…the insulin form pages."

I (RN) try not to page MDs with stupid scut orders. I'll try to at least collectively page the MD with other RNs, so 5 issues with 5 different nurses can be solved with one page. Or I'll just leave notes on the front of the chart, so the regular team can handle the scut. However there ARE anal interns/residents/PGY1s that WANT to be paged about everything and anything (e.g.: pt has not had a BM for 1 day, pt feels "anxious" b/c of upcoming sx...yes seriously), and they want to come up to assess the patient before giving a telephone verbal order for a sleeping aid x1(like Zoplicone) or a Tylenol PRN order for chronic knee or hip pain. I work in a teaching hospital so I've met a lot of interns/residents/PGY1s.

I definitely feel sorry for you though. I can't imagine the stupid crap you have to put up with, and the hundreds of pages that you must get each call. I can't even have a 2 minute conversation with any of my MD friends when they are on-call w.o their pager going off. The fly-in on call last night was paged 911, for a DNR patient who had just died on the geriatrics floor. we had a good laugh, but i could tell that part of him wanted to cry.

- nurse charlene

9:12 AM  
Anonymous Anonymous said...

you were missed handsome doctor.

10:19 AM  
Blogger Serena said...

oh good god. i'm about to start intern year in 2 months. oh dear lord. just shoot me now.

1:12 PM  
Blogger Joel said...

Awesome to have you back, FakeDr.

5:18 AM  
Anonymous Anonymous said...

HAHA all right!!!!The fake doctor is back!

Great blog post as always dude, but all the above comments said it a lot better.... so ill just simply say: WORD! Keep up the great work :)!


5:56 AM  
Blogger Sunny said...

Missed ya!

2:17 PM  
Anonymous jane doe said...

You want to join this group. Seriously:


10:31 PM  
Anonymous Anonymous said...

Fake Doctor, good to see you back. Interestingly (for me anyway) I've been having a parralel (though not identical) experience this year... my first year of clinicals. Running into the "ills of society" has been one of the most daunting parts of my task as a third year med student, that along with insane attending who ask impossible questions and then ignore your geniusly correct answer, tracking down nurses who stole your chart while you turned your head, watching medical errors endanger the lives of patients, and more.

One quick reminder: Though it's doubtful you'd so quickly forget, remember the hell we med students are going through, too. You work longer hours, for sure, and should help you with the massive amounts of scut, but remember to treat the nice hard-working ones nicely. Do what you will with the asshole gunners.

All the best


3:43 PM  
Anonymous Anonymous said...

I am working for an ambulance company while I finish up my undergrad and know all about the pager issues. They decided to page us at 3am letting us know that we're on our "30 minute lunch" which they can interrupt at any time to give us a call. I would rather sleep. And worse, we are issued nextel phones which dispatch loves to abuse the PTT function on. Nothing worse than being woken up at 4am to then have to talk to some dyke whore telling you there's some douchebag who called 9-1-1 because of "foot pain" who you then have to transport to the hospital 15 miles away when there are like 4 within 2 miles (because that is her favorite) to abuse the medi-cal system....

11:30 PM  
Blogger Xavier Emmanuelle said...

Thank goodness you're back, I needed another procrastination tool to distract me from my organic chemistry final...

11:41 AM  
Anonymous Anonymous said...

Hooray you're back! I'm a lab tech and today I had a nurse call down from extension 32167 (ICU? Resp? Morgue?) to ask if packed cells were ready for bed 6. Oh, bed 6...yes, right beside the apheresis platelets for lamp 12.

Keep up the posts. We missed you.

4:58 PM  
Anonymous Brandon said...

Glad to see your cynical, bittersweet side is back! Keep strong, we're all rooting for you.

7:32 PM  
Anonymous Anonymous said...

You have much angst. If you have a Facebook account, may I direct you to the 'Bleep Etiquette' group where you may meet hundreds of like-minded people for group therapy. I feel your pain.
-- Fellow sufferer who finished intern year 3 days ago

11:13 AM  
Blogger Doctor Ayche said...

I am so happy you are back! I read all of "Ah Yes, Med School" last summer before starting medical school myself. It was greatly entertaining! Keep blogging!

1:30 PM  
Blogger L.Bo Marie said...

yeah, you were missed...
get some sleep, post some posts, breathe... it's nearly over.

8:47 PM  
Anonymous isya said...

after a long wait....u r back
im very happy
actually very very happy.

3:05 AM  
Anonymous Anonymous said...

im super duper excited that you have returned! i miss the entertainment!

9:21 AM  
Anonymous Anonymous said...

Hurry up and write another blog, dickwad! I need something entertaining to read.

12:53 PM  
Blogger genderist said...

You rock.

2:56 PM  
Blogger EE said...

Welcome back, doctor

8:36 PM  
Blogger Medic61 said...

I am such a fan of this post. Having grown up with an OB/GYN dad, I vividly remember this conversation happening roughly each time he was on call.

"So you say you've been bleeding? *pause* Uh-huh...how long has this bleeding been going on? *pause* Ma'am, I have to ask: if you've been bleeding for the past six weeks, what changed so that you had to call me at 11pm on a Friday night?"

Now, as an EMT, I get to have the same conversations.
"Ma'am, why exactly did you call me out here at 3am? Oh, your foley cath is leaking radioactive urine? Let's go."

Can't wait for more posts :)

10:21 PM  
Blogger Kirsten said...

New reader here, EE from over at Backboards and Bandaids suggested we stop by. So glad I did.

Please be to knowing that I a nurse that will NOT call you with something stupid at 3am just because the other 3 nurses I am working with deem it NECCESSARY. TO. CALL. RIGHTNOWKTHXBAI.

10:48 PM  
Blogger Heather said...

I also try not to page the docs with stupid crap at 3am. If it can wait until morning, I am a firm believer in post-it notes.

I love working in an academic hospital. For the most part, our residents are pretty good, unless they are in family practice. However, any resident who pisses off the nurses may as well kiss any chance of sleep good-bye.

Good to see you back. I'll be linking your blog.

10:00 AM  
Blogger X-ray Rocks! said...

I just found your med school blog today.
Very funny!
Finally I understand what/how/if med students are thinking.

7:13 AM  
Anonymous medrecgal said...

OMG, you're back! I totally missed your often sarcastic, hilarious, and witty commentary on med school... Now we get residency, too! Just a wannabe who ended up in HIM for a dozen reasons, but I always enjoy your blogging!

2:51 PM  
Anonymous Anonymous said...

So glad that you are back!!!! Keep your head up! You are a rockstar!!

1:45 PM  
Blogger Larissa said...

Glad you're back!

6:35 PM  
Blogger Tracy said...

As a lurker (and RN lurker at that) who loved reading "Ah Yes, Medical School" I thought I would finally jump out from behind the bushes and offer some measly words of encouragement that only a seasoned medical professional can muster. SNAP OUT OF IT!

Seriously though, I empathize with the frustration, aggravation, depression et al very well. All I can say is hang in there. The fact that you feel above noted emotions means you are going to be a GREAT doctor. The ones who suck are the ones who aren't affected in the least by how medicine is "working" these days. I have always thought to myself that the day I quit worrying will be the day I leave to begin my new career as a barrista.

You can't see them from there but know I'm shaking my pom-poms for you and sending lots of good sleep karma your way.

11:36 AM  
Blogger Old MD Girl said...

I take it you've gotten good at biting down on your tongue REALLY REALLY HARD.

Chin up. Everyone tells me that 2nd year resident life is infinitely better than intern year. And you only have 6 weeks until that starts.

I'm glad you're back too.

5:35 AM  
Blogger Old MD Girl said...

Oh yeah.... any thoughts on whether prophylactic SSRI use does anything to stem the intern malaise?

5:38 AM  
Blogger C. Ryan said...

Midly Disturbing

7:40 PM  
Anonymous Anonymous said...

Forgive me for my selfishness. My girly impatience was becoming too much to handle, awaiting your return. But alas, you are here, and all is well again.

10:58 PM  
Anonymous Anonymous said...

As another RN (or to be, coming in June!), I'm so sorry that you got called with all that stupid crap! Even as a nursing student, I wouldn't call a resident at 3am to talk about insulin sheets, blood sugars at 120, or lack of bowel movements.

Glad to hear you're back! What specialty are you in? Endocrinology?

3:46 PM  
Anonymous Anonymous said...

I about died laughing with the part about getting a pager as a medical student and getting phony pages. When I was in medical school my friends and I would send each other text pages all day (whenever we could break free) and I swear that got me through some otherwise miserable and unbearable clinical rotations.
Likewise as a resident I dealt with the same ridiculous stuff from the floor nurses.
The thing of it is, they don't seem to understand that when they work their shift, go home, and then come back in the morning the on-call person has NEVER LEFT.
That just doesn't register with them, how long you have been there and how much you've been dealing with.

4:45 AM  
Blogger FoMo, M.D. said...

Yes!!!! You're back!

8:23 PM  
Anonymous Alice said...

Crying with laughter. Absolutely hilarious, and so true it's almost not funny. Nice to have you back. Four weeks to go, eh?

5:41 PM  
Blogger afreakforjc said...

Good post! Me like!

5:29 PM  
Anonymous Bravofriendly said...

Welcome back!!

8:36 AM  
Blogger dr.stethoscope said...

Wow. No matter how terrible your intern year is sounding.. this is so motivating to me as a first year med student..

10:52 PM  
Anonymous docwhisperer said...

Thanks for the memories, some things never change. I'm reading this many, many years after my crappy internship, and I can definitely tell you, in the long run, it will be worth it.

At least I hope you've met some nice girls wherever it is you're working.
P.S. If the nurses keep paging you at 3AM, it means they hate you.

7:20 PM  
Blogger Abi said...

Glad you're back, love reasing your blog on med school. This might sound selfish, but my first thoughts were "I wonder what kind of residency he's in..." Will you be regaling us with your stories for 3 years or more? :)

6:14 PM  
Blogger sarah said...

love the pages. god i SO don't miss being an intern.

3:51 PM  
Anonymous Anonymous said...

My guy is a resident at a NYC hospital. Now I understand his frustrations. I want to hear more tales of doctors interacting with each other...sans pager antics...

8:07 PM  
Anonymous Anonymous said...

My man is a doc in NYC, HATES his job! Tell me more about docs interacting with each other.

1:43 PM  

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