It’s 3 AM. I’m lying in a dirty call room at the hospital. My eyes are closed, and I’m just getting into that hazy twilight that precedes sleep when it happens. BeepBeepBeepBeepBeep….my pager goes off – again.
I dial the number on the pager. “Hey. It’s Dr. Howard.”
“Yes, Dr. Howard, I paged you because this patient is complaining of shoulder pain and there is nothing ordered.”
“Okay. I’ll put something in.”
I drag myself out of bed and out into the hallway where the nearest computer is located. Still half asleep, I log on and put in an order for percocet. I then head back to bed.
Ten minutes later. BeepBeepBeepBeepBeep. Another page.
“Hey, Dr. Howard. This patient doesn’t have a diet order in, and I’m wondering if she really needs to be NPO?”
“Yeah, I think the primary team was concerned for aspiration, so we will just keep her NPO. If they want to feed her they can change it in the morning.”
Twelve minutes later. BeepBeepBeepBeepBeep.
“Ya, Dr. Howard. This patient is complaining of blood when she pees. She says it has been happening for four days.”
“So ya, I’m not really sure what you want me to do about it right now. Her primary team already knows, and they haven’t been doing any further work-up So I will let them know, but we can just watch her for now.”
“Dr. Howard, this patient’s blood pressure is 89/56, but she has been hypotensive this whole admission. Just wanted to let you know.”
“Hi, Dr. Howard. This patient is still having 8/10 shoulder pain. He refused the percocet, and now he wants to talk to you.”
“Okay. I’ll be there in a minute.”
Abandoning all hope of taking a nap, I walk down the hallway to talk to the patient. Trying to remain strong and not be suckered into a demand for a stronger pain medication. Meanwhile, the nurses spot me.
“Hey! Are you Dr. Howard!? I was just about to page you about my patient in bed 6. He wants a nicotine patch.”
“Oh, Dr. Howard! There you are. My patient wants something to help her sleep!”
“By the way, Dr. Howard. This patient lost her IV and she is refusing to let me put another one back in.”
Sigh. Being the night float intern means getting paged about anything and everything at all hours of the night. You’re the doctor taking care of all the other interns’ patients while they are gone, so anything the nurses need, has to come through you. Sometimes it’s really important, like a critical lab value or a patient complaining of chest pain. Sometimes you have to wonder if the nurses are just bored and playing a prank on you.
And you never know what the next page will bring. Hopefully it’s something simple, like renewing a foley order or ordering some benadryl. But there’s always a small amount of fear that a patient will be decompensating, and you’ll be called upon to know what to do. So far I’ve managed to keep all the patients alive, which is always my primary goal. But I’ll be working nights all month, so I won’t count my chickens just yet!