Top 5 Worst Pages
This really should’ve been our first Top 5 list, but our staff couldn’t agree on which pages should make the shortlist. After all, a bad page has as much to do with its timing, as its reason. The most benign page can be the one that tips you over into the raving lunatic, screaming at his or her 2″ x 3″ electronic noise maker. The ones on this list, though, can inspire fear, frustration, and occasionally, acute depressive episodes, in any resident. They are the ones that usually involve some type of “work-up,” and tend to occur during the late night hours. Sit back, turn off your pager, and feel the pain…
1. CODE 99 - (Or whatever you call it at your hospital) - The mother of all pages. Someone is decompensating and the page operator’s smoke-crusted voice is echoing from the overhead speakers where. The first thing every housestaffer thinks is, ‘I hope it’s not my patient?’ The next thing is: ‘when do I shock and when do I give meds? Damn why didn’t I listen more in ACLS? What’s the differential for PEA again? I know it’s hypo-somethings.’ And the last thing that you think as the elevator door opens is: ‘Don’t let me be the first one there.’ Most often, in fact, you spot the codee’s room by the crowd of people spilling out in heirachical order, medical students standing on the periphery trying to get a peek. As you wade past the code cart, interns, then nurses and finally residents you are most often met by a patient who should not be coded in the first place. The critical care fellow makes an appearance towards the end and successful or not, the patient is deemed not an ICU admission. Good luck with that one.
2. BRBPR- This page is so painful that seeing the letters together make me gag a little bit. Picture the scenario: It’s 3am, you’re asleep in your call room and the pager vibrates (if you don;t have your pager set to vibrate then you are asking for a breakdown.
MD: “Someone paged nightfloat?”
RN: “Yes, doctor. Patient Smith, there’s a lot of blood coming from poo poo.”
MD: “From where?
“RN: “You know, caca?”
MD: “What?”
RN: “There is bright red blood from rectum.”
MD: “Shit.”
RN: “That’s right.”
MD: “I’m coming.”
In your head, your already contemplating the torture that awaits you as the elevator doors open. The smells, the sights, the sounds- all blending together to make one dizzying cocktail of pain. Call the attending, Type & Screen, CBC, transfuse, look for source, talk to family, and don’t forget to spread around the pain a little bit- call GI and surgery. Oh, the torture.
3. “Patient found on floor”- Oh, Dear G-d. Another one laden with all sorts of horrendous outcomes, ranging from broken hip to laceration of whatever, to emergent need for head CT. The torture can be made even worse if they happen to leave all the lines that were once in them, on the bed. Which brings us to #4….
4. Patient pulled out Foley- This one may be tougher for the guys to handle than the girls, since we can relate so intimately to pulling a 2 cm inflated balloon out of your urethra. I just gagged again. There’s inevitably some blood coming from the most sacred of all places, and that sight alone puts this page on the list. Not to mention the urine, and the delirious/demeted patient that’s sitting in it. The only worse part is trying to get GU to come see the poor guy.
5. Anything after 3am that’s not emergent- They could page me to to say that I had won season tickets to the New York Giants and I would still be pissed. Anything having to do with refills, renewals, restraints, rehabs, or re-IV placements can be done at 6am, when we’ve gotten an hour of rest and are through the torture of the 2am-5am “period of pain,” during which one, two, or all of the preceding 4 nightmare pages usually occur. Sometimes you ponder how they could page you at 5am to ask if the patient still needed 0.5 NS running at 125 cc/hr? And then you remember- it’s just part of being a housestaffer.
