Beep beep … beep beep … beep beeeeep….
Taking call as the AMO, or admitting medical officer, was one of the most heinous call experiences for upper-level residents. The AMO had the great fortune of being paged for every single medical admission to the hospital between 5 p.m. and 8 a.m.—regardless of acuity—and then triaging to the appropriate floor. She or he was also responsible for running all codes on the medicine service, seeing all medical consults from non-medical services (like surgery or psychiatry) overnight, assisting with all needle sticks and exposures, and backing up any resident or intern covering a floor who couldn't seem to pull his or her weight. The AMO was the destination for advice calls, hospital transfers, and the default for nurses who didn't know who else to call—especially if they knew you.
Once someone paged me to ask directions to Jacob's Field for an Indians game. That pager was like 411, 911, and 0 all rolled into one tiny box. That heinous box! It went off All. Night. Long. Worse, there was some kind of wire loose in it, so instead of beeping, it sort of bleated. A slow, nauseating bleat in an escalating, nasal pitch. I feel sick just thinking about it, which is the same Pavlovian response I had back then.
The AMO call night from hell
It was a cloudless spring night in Cleveland, the kind that made being in the hospital overnight that much worse. The hospital was busy and full, but not full enough to be closed to new admissions. This particular night, the patients were sick. Not just sick, but really sick. The bleating pager was unrelenting.
For every patient I saw, I stuck his or her identification sticker on the right leg of my scrub pants. By 2:30 a.m., my right leg was covered with labels. Twenty-six to be exact. I'd already run two codes, dealt with a needle stick, and helped the residents covering the ICU place an arterial line. Then, twenty whole minutes went by without the pager making a bleat. Could it be? A moment to sleep … perchance to dream?
I made it to the ninth floor and into the call room. I kicked off my clogs, dove onto the scratchy sheets, and, just before closing my eyes, yanked my pagers off my waist and placed them onto the dreadful hospital-issue pillow right beside my head. Within two seconds, I'd fallen asleep. The time stamp on my pager read 2:50. Zzzzzzzzz….
BEEP BEEP … BEEP BEEP … BEEP BEEEEEP ….
“Please no,” I said aloud. My eyes flew open and looked at the ceiling, which had some kind of disgusting water stain on it. The impatient pager began bleating again. I repeated, “Please no.” I was so tired I could vomit. This is exactly why folks always advised against trying to sleep on busy call nights. The only thing worse than no sleep was this: the sleep tease. It was now 2:57 a.m.
I looked at the pager and breathed a sigh of relief. It was a number I recognized, and most important, it wasn't from the Emergency Department. At the very worst, it was a sick patient. At best, it was someone asking a clinical question. I rolled over and dialed back the number.
“Hey, Kim … this is Mark, the intern on 9B.”
“Hey Mark,” I replied trying to sound as chipper and welcoming as possible, despite the lingering nausea. “Is everything okay?”
He let out a nervous laugh. “Umm … well, yes and no.”
Mark was an excellent intern. He was mature, organized, responsible and a great independent worker. I knew I could trust whatever he said, and could count on him to follow through with my directions. “Ummmm … so, I've gotten five admissions tonight, and they're all fine … but … uhhh … I, like, haven't seen my resident … since … I don't know. Like 9:30?”
I bolted upright in the bed. “What? That makes no sense. I've called all of the admissions to Nick directly. How have you even known about them?”
“Well, that's what's weird. He's called me with the admissions and that's it. I haven't seen him otherwise.”
“Whaaat?” I asked again. This was crazy. The drill was simple. I get the admission. I go see the admission. I decide if the admission should go to the floor, the ICU or telemetry. I call the resident covering the floor. The resident calls the intern and they go see the patient. The intern writes the orders, and both the intern and resident write admit notes. Simple enough.
“Give me a couple of seconds. I'm coming over there to help you,” I said. I slammed down the phone and jammed my feet into my clogs. I was so tired. Too tired for drama, which is exactly what this sounded like. I picked up the phone and paged Nick. Two seconds later, I was startled to hear his pager go off in the call room right next to my own. The dude was right beside me. Despite realizing this, I still leaped when I heard the phone jingling on the nightstand right beside me. Well, at least he was answering pages.
“Uhhh … Nick?” I answered.
“Hey Kim, what's up?” Okay, I could hear him through the receiver and the wall. Sounding all chipper and wide awake. I smacked my palm over my face and shook my head. Before I could even say anything, he said, “Got a patient for me?”
I was too tired for this. I said, “Hold on for a minute,” lay down the receiver and looked at my leg full of patient labels. Here's the thing: Nick was covering not only Mark, but also Jeannie on another floor. She'd been given four admissions in addition to Mark's five. I marched out of my tiny room, walked next door and banged on Nick's call room door. Hard.
Either he was slow or hard of hearing. Nick opened the door like he was expecting to see housekeeping with new towels. He jumped back when he saw me. “Oh, hey Kim!” he said wiping the sleep from his eyes. His thinning hair screamed “bedhead.”
I scanned the room. The TV was on. VCR player with tapes sitting on the nightstand. An empty Diet Coke can and a half-eaten stromboli lying in an open box. A honeybun wrapper, a crumpled bag of microwave popcorn and some coffee that appeared to be from hours earlier. It looked like a hotel room with excellent room service. In other words, this dude had been CHILLING. All. Night. Long. I placed my hand on my right thigh, to keep me from kicking his butt right then and there.
I wasted no time. “Nick, Mark said you haven't seen any of his patients. What's going on, man?”
“Oh, I knew I hit paydirt tonight. Mark and Jeannie are strong. Those guys are on auto-pilot, man. I told them to call me with questions, so as you can see, they didn't need me!”
“Are you serious or are you joking? Have you not seen the NINE patients I've called to you? What the hell is wrong with you?!”
“It's May. They are almost residents,” Nick replied with a shrug.
“But they AREN’T residents,” I shot back, unable to hide my anger. “Dude! You're supposed to see the patients and review their orders and also write your accept note—you know that! What the hell, Nick?”
I couldn't believe this. Sure, everyone knows that some residents and doctors can be a little bit shady. But this was so egregious … hands down, the shadiest, laziest thing I'd ever seen. And I knew what this was about to mean. It meant I would be seeing and reviewing all of the orders and writing all of the notes. This would have me working at a breakneck pace until morning report. I was so, so tired. I wanted to throw up. On him.
“You're overreacting,” he retorted nonchalantly. “Bet you didn't know that the attending bills from the intern note, not ours. We don't even need to write a note, technically.” He smiled wide with his big yellow teeth.
I couldn't take it anymore. If I didn't get away from him, I'd be arrested for assault and battery of a lazy classmate. I spun on my heel and left without another word.
I walked briskly from hall to hall like a mall power-walker. For the rest of the night, I did Nick's job and mine. I answered random pages and reviewed orders, plans and findings with interns. I did not sit down for more than five minutes for the rest of the night. It sucked.
The following day was my clinic day. As a combined Internal Medicine/Pediatrics resident, every Thursday afternoon I alternated between my Internal Medicine clinic and my Pediatrics clinic. This happened whether I was on call, post-call, no call, or any other state you could think of. Any chance of leaving the hospital early was out the window. Despite my night from hell, this was just the way it was before duty hours reform. This sucked, too.
Post call clinic—going on 34 hours straight of working
At about 3:45 p.m., I was sitting across from my attending telling her about one of the patients I'd just seen. All of a sudden, I felt someone shaking my shoulder and calling my name.
I jerked awake and immediately realized that my mouth had been wide open. Hanging from my glistening lower lip was a long piece of drool that had collected into a large puddle on the desk. The pen in my hand had captured writing that had gone from sloppy, to tiny and not discernible, to one flat, diagonal line across the encounter form. Nice.
“Go home,” my attending spoke with a mix of concern and disgust. “In fact, go to a call room until you can get someone to give you a ride home.” It was one of the kindest yet most mortifying moments I'd experienced in my four years of training.
I can't tell you that I went to a call room to sleep. If I recall correctly, I had two shots of espresso, rolled down the car windows and smacked myself in the face repeatedly while reciting the song “Rapper's Delight” all the way home.
Two days later, I was AMO again. Great.
So the good news is that this horrid workfest would never happen under the current resident duty hours regulations. And to that I say “Hallelujah.” Drooling all over a desk when you're old enough to vote is not good.
I bet you're wondering what happened to Nick. Well, I told the chief residents, who thanked me for stepping in. I suppose somebody scolded Nick at some point, but in the end, he smiled and received his residency diploma right along with the rest of us. Now he's probably somewhere doing who knows what.
I should have kicked his butt when I had the chance.