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.”
BeepBeepBeepBeepBeep.
“Dr. Howard, this patient’s blood pressure is 89/56, but she has been hypotensive this whole admission. Just wanted to let you know.”
“Ok. Noted.”
BeepBeepBeepBeepBeep.
“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!
my first patient 
Enjoy! My favourite bleep of all time has to be the one where a nurse bleeped me to say that he’d gone to see a patient who had asked for a sleeping tablet earlier, only to find the patient already asleep, so he WOKE THE PATIENT UP to ask if she still wanted the sleeping tablet. And she did. Obviously.
Oh this took me back to my intern year! I can still remember how proud I used to feel going back home the best day after a hectic yet somehow fulfilling night shift! 🙂
Good luck to you for rest of the shifts, this is the only time you get to learn so many things all at once, try to absorb as much as you can 😄
Sigh. I remember those nights well…it made me write better orders when I admitted, though. Tried to think of all the medication needs to lessen the calls at night -pain, nausea, constipation, insomnia…
Yes! I feel like it was such a good experience because now that I’m back on days I think ahead and write much better sign-outs than I used to. And I anticipate what could potentially happen when I’m away!
Just so you know Emily, I have just about given myself an ulcer waiting on calling a doctor because I feel like it can wait, but then second guessing myself ALL night long. We HATE waking up a doctor at our facility. I don’t know any nurse who wants to call a doctor. I don’t even like calling them in the daytime. HA! Hang in there, this too shall pass. Your blog is very interesting!
I have been called to be informed that the inr was high . Since the lab value of 2 shows up as abnormal . Enjoy your time in residency . It only gets worse . Later you will get calls for even weirder reasons. The nurses in teaching hospitals are more ruthless as far as calls are concerned ( you are not a real doctor after all😊) but atleast they re better trained compared to community nurses.