#8: Did you really have to page me about this at 3 AM?

There were a bunch of really crappy pages on Friday night call. There were multiple times when I would be paged to a phone number and I'd call back withiin 30 seconds and the person who paged me was not there anymore. After waiting for 3 minutes on the phone someone might pick up to ask: "Did you really mean to order Mr. So-and-So a diet?" Yes, I did. There was the time at 1 AM that a nurse paged me every 15 minutes for 45 minutes saying that Mr. Narcotic-Seeker wants the equivalent of 90 mg of morphine and that we'd only written him for the equivalent of 45 mg of morphine. I'd been ignoring this nurse since she'd cancelled a bunch of lab orders I'd requested earlier in the night and then she didn't tell me that she'd cancelled them. Yes, Nurse Ratchet, Mr. Narcotic-seeker doesn't get to have his 90 mg of morphine. Please see the clinic note on the computer saying that he is under a pain contract to only get 45 mg of morphine for the day and do you really believe he's in that much pain? She didn't page me any more after that...

Then there was the page at 3 AM:

Nurse: Mr. End-Stage Rectal Cancer has an extremely high blood pressure of 150/105!
Me: What is his pulse?
Nurse: Hold on, let me check... Just wait on the phone for 2 minutes doing nothing while I go do that.
Me (internal dialoge): Yes, heart rate is a very basic piece of information in order to interpret blood pressure - did you even stop to think for 5 milliseconds about why his blood pressure was so high? Do you think it might be because you forgot to hook up his pain medicine earlier in the evening?

The ultimate page at 5:30 AM was "Mrs. Small Bowel Obstruction has a low blood pressure of 85/50."

I return the page in person, showing up at the nurses station 30 seconds after being paged, only to find no one is anywhere to be found. I check the patient's chart, looking for how much urine output the patient had and how much fluid had been suctioned out of her nasogastric tube, only to find that no one had recorded any vitals in the patients chart so I have to track down the nursing assistant who is carrying around all the vital signs for the evening in his pocket.

Me: How should I try to figure out what is going on with this patient that you are paging me about if you don't record what is going on with the patient in the chart? Please hang half a liter of fluid in order to replace what we sucked out of her stomach.

I have an excellent relationship with most of the nurses that I work with, but all of the pages I got above were from nurses on the trauma floor, who are used to the doctors being mean to them. I am always extraordinarily nice and usually I try to make the nurses feel like they are doing all of the work for the patients and I try to involve them in the decision making process, but I feel like I got handed a load of crap from the trauma floor on Friday night (Saturday morning.)

Patients covered last call night: 45
Amount of sleep last call night: 90 minutes (from 4 AM to 5:30 AM)
Currently reading: Greenfield's chapter on Abdominal Wall Hernias
Currently watching: Miami Vice (we saw it last night and I thought it was a great movie! Michael Mann is on top of his game. I used to be a huge fan of the TV series as a kid and I own Seasons 1 and 2 on DVD.)
Next call night: Tuesday, August 2, 2006 (I am moving teams from the Gastrointestinal Surgery team to the Surgical Oncology team.)