The Tyranny of the Night-Shift Pagers
The little black beeper stays with us, day in and day out, for the entirety of our internship training
At night, the hospital is a different world. Typically slow the elevators arrive instantly, the corridors are darkened and there are fewer members of staff around. Every patient in the hospital is covered by “night floats” – interns and residents who work the night shift, looking after already hospitalised patients and admitting new ones.
Early in the evening, there is a deceptive calm. And then the beeper’s rapid fire begins. For most of us, intern year (the first year of residency) means receiving a little black pager, or beeper. It stays with us, day in and day out, for the entirety of our training.
As an intern, you’re first in line to be paged. There were nights during my internship when I just couldn’t keep up with the onslaught of pages – some urgent, some relevant, and others just the numerous “FYI” messages to which I was never quite sure how, or even if, I should respond.
The beeping was incessant. At times, while covering more than 60 patients, I rushed up and down stairs, directed by the pager, managing crises. I remember one night shift, when, at 6.30am, I finally got to go to my call room bed. As my head hit the pillow, a nurse paged: “Mrs X is agitated, trying to go to the bathroom but can’t. Asking for Donnie.”
I got up and went to Mrs X’s room. She had the hospital delirium look about her – a crazed, fierce look in her eyes. I checked my handover note from the day team: “patient delirious and confused. Call Code Grey.”
A Code Grey means that four hefty security guards arrive and hold the patient down until we figure out what to do. Not a permanently viable solution. Instead, I suggested we give her 5mg of IV haldol (an antipsychotic medication used to calm delirious patients). We also put her on the phone with Donnie, and finally she calmed down. We turned out the lights. I ordered a further 5mg of IV haldol and gave it to the nurse. Just in case.
Ten minutes later, a page summoned me to Mrs M, who had tripped on her IV pole trying to go to the bathroom. “Patient is on blood thinners. Did not hit head. Please assess.” I was shocked at the scene that greeted me when I arrived. Mrs M was being moved back into her bed and was swinging mid air in a motorized lift – a contraption I had never seen used before. Mrs M had bruised her shoulder and wrist but that was all. Relieved, I advised ice, rest and no unaccompanied trips in the dark to the bathroom.
Five minutes later, paged by nurse: “Mrs F has passed. Please come and pronounce patient, notify family and complete paperwork.” As I raced to Mrs F’s bedside my pager was already beeping about something else.
But right then I had to telephone a family to tell them that their mother/sister/daughter had died.
On this night, as on most others, the beeps just kept coming. Many related to patients who were delirious or in pain, but how was I supposed to handle the avalanche of FYI pages? “FYI patient is constipated.” “FYI patient would like to go and smoke.” “FYI patient’s family is here.”
With more than 60 patients, I had to prioritize – so that was I expected to do with all these non-urgent FYI pages? Sometimes I felt that I should be included on a “need to know” basis. Yet the NTK acronym hasn’t caught on in medical speak. Perhaps it should.
Now, as a second-year resident, I have an intern working with me and the relative silence of my own pager is blissful. Sometimes a loud beep startles me. As I reach for my waist, I catch sight of my intern doing the same and I realize the sound is coming from him. “FYI … ”
Financial Times Weekend Magazine | August 19, 2011