Tuesday, August 24, 2010

on page, part 2

take it down a level
i'm on call this week. as i mentioned yesterday, i'm trying to bring my call stress level down a few notches. because truthfully? there is no reason for the repetitive cortisol surges every time my pager goes off (clearly, my adrenals work fine, as opposed to what seems like 99% of the babies in the NICU). i can do a better job, be a nicer person, AND have a more positive experience when i don't rush, overly stress out, or let myself become overwhelmed.

let's start by taking a step back and admitting that i am not yet taking my pager's ring in stride. honestly, i think it might be a bit of a pavlovian thing left over from residency. because back then (yeah, WAAAAAAY back then -- as in 2 months ago!) i carried a pager that did sometimes require running into an emergency situation and perhaps warranted a bit of adrenaline.

but now?

yeah, most of the tme, i get super urgent pages like the above about follow-up appointments and DDAVP dosing. i mean, come on -- it's not like "QUICK! help me interpret these thyroid studies, STAT!".

sometimes i get alert lab values which freak me out a little, but if i really stop and think about it, lab results aren't instant, and the kid behind the number has been okay for the hours of processing time, so ACK!! OH NOO!! responses to ugly sodium numbers (even if they are termed 'panic' values by the lab) don't make much sense, either. a calm and thoughtful approach is better for the patient, the caller, and for me.

by far, the most panicky calls (and therefore panic-inducing -- unfortunately, freakouts can be contagious) are the ones from parents, usually describing a scenario that is concerning for adrenal crisis or DKA. but really, if they have time to make a phone call through our switchboard (this can take a while, apparently), then i have time to breathe and reassure and think through their scenario before choosing between option A (continue to watch the child at home and follow up) and option B (tell them to high-tail it to the ED).

so today, when the pager goes off (and ohhh it will), i am going to take a minute and breathe/visualize a seascape/sneak some ativan (KIDDING), whatever it takes to try to alter my previous conditioned response. hopefully i will someday be able to glide through my work days -- pager beeps included -- with a calm and positive energy.

if you are in the medical field, what is your response to your pager like? and if not -- is there an equivalent stimulus (blackberry beep, email heading, phone call from the boss) that makes your hair stand on end and your adrenals cry for mercy? i could certainly use your tips + coping strategies!



workout: 35 minutes elliptical + full-body weights circuit

making it easier: i've decided that mondays are going to be official pizza nights in our household. we have a conference that lasts until 6 and the day tends to be a busy one overall, so why not make things just a little bit easier?

luckily, there are a number of frozen pizzas that i like (and don't feel horrible about from a nutrition perspective). pictured above is 2 slices from the american flatbread pie -- this is actually quite no-frills pizza that tastes like the neighborhood pizza joint to me, with plenty of cheese and a bit of oregano.

boards/reading: i spent ~2 hours after work dictating and handling calls, so genetics is getting pushed back a night. it will be okay.


  1. I have a pager for my dietetic internship, but no one has paged me yet! Mine definitely isn't as fancy as yours appears to be -- it just shows a phone number and that's it.

  2. I'm into my 2nd straight week of pager call including last weekend, so 12 days in a row. One of my tricks for when patients (or in your case parents) call at odd times or with strange complaints are that most of the time they are calling because they are scared and I try to reassure them, even if it does not require a lot of medical action. Think about if you were a parent with a sick kid and had no medical training and didn't understand what was happening. Also, don't you think it's funny that nobody carries pagers anymore but on call doctors and even then many use cell phones. I hate lugging that thing around.

  3. meredith: hopefully that thing will stay silent :)

    julie: actually - i think it would be worse if i could be called directly! i'll pick a page over a cell phone call any day. with a page, you can take time to regroup, look up something (if there's info on the page), etc -- and in fact i'm going to try to take advantage of that little lag time.

    if i could only turn the ring sound to a zenlike meditation gong sound . . .

  4. This is such an "Oh, duh," moment, but I spent the weekend with friends, one of whom is a first-year neurology intern. I have to say, I had NO IDEA how much you all work. It was a complete awakening, and it truly blew me away. You must really love doctoring to go through all that. Suddenly your need for organization is becoming a lot clearer! Anyway, as Andrew marched off to his 15-hour workday on Saturday, I thought of your blog.

  5. Definitely not stress inducing, but when an article comes back from getting prepped for publication my boss insists we go through the page proofs THAT DAY. Which means going word by work, redoing all the analyses I haven't run in weeks, checking every single digit and graph footer, etc because this is the last chance we have to catch any error before it's set out for the world to see. Ick.

  6. Your response to the pager reminds me of myself when Miles was first born. I would bolt out of bed and run over to his crib the moment he made a noise for the first few weeks. After awhile, I got used to the interrupted sleep and would take a little more time to get out of bed. I'm sure you will get into a rhythm and will be a pager pro soon! Good luck!

  7. Anonymous10:18 AM

    i like the thoughtfulness of this post. always good to remind yourself that you can take the time to breath and things will be okay. but i feel you about the pavlovian response to things. i definitely have them too!

    so far nothing like that on my end for my job. granted i'm only on day 7 so we'll see how my year goes...

  8. Anonymous11:19 AM


    On of my tips for dealing with adrenalin rush experiences is to remind myself that the physiological sequelae of panic/fear are very similar to the experiences of excitement. So....wonder if you restructure your thoughts to say that you are excited to get the page--exhilerated to face a challenge, use your skills, apply all of the knowledge you have learned. I've worked hard on this and while not perfect, it has helped me.

  9. I still have that Pavlovian response to a pager going off. I had to carry one when I worked as a software engineer, and it never failed to elicit mild panic. And now, five years into my nursing career, the charge nurse pager has the same effect.

  10. DEFINITELY prefer a pager over a direct line to me. Pager provides a barrier, small though it is! I tend to kind of ball up on the inside as I tentatively hit that button to find out who is paging me, hoping that it's "just the floor" or "that kid I already know is coming" instead of a new admit! :-) The really annoying ones are "just wanted to make sure that you really want me to give the Tylenol that's already ordered" or even better the attending who wants me to come write discharge orders as she stands there watching me do it...yes, you are an attending and can write you own orders WITHOUT a scribe! The same attending did this to me TWICE!

  11. Anonymous5:56 PM

    I'm a social work intern in the PICU and every time the beeper goes off, I think "what has someone done now and how am I going to fix it." Luckily as an intern, my supervisor's pager goes off much more than mine.

  12. I am not in the medical field, but have this intense dread of phone calls in general. I always think it is bad news, and if I don't know the number, I just won't answer. But you can't really not answer your pages!! I bet your job is pretty intense at times. Thanks so much for the comment!

  13. Ashley10:42 PM

    I'm in my second month of intern year in internal medicine, and I'm amazed at how quickly (say within the first hour of my first day) I became to hate the pager. I think I outwardly cringe when it goes off. And to think as a med student only 2 months ago, I was excited to be paged. Craziness.

  14. atilla11:05 PM

    in general beeps don't bother me but a ruptured aneurysm will get me excited

  15. The patient call system at the hospital ALWAYS get me. Our new systems goes, "ding, PATIENT CALL." And repeats that until someone answers it. I was in the grocery store yesterday and thought I heard it. The calls annoy me if I'm in the middle of something or if I was JUST in the room. My patience level with them definitely changes with the situation. Many times it's an "ugh what do they want??" feeling. Probably bad, but it's true.

    The WORST sound ever isn't the patient call system, but the BED ALERTS. We use them on people who are fall risks who get out of bed on their own and might fall, which generally means I go running down the hallway to make sure they don't fall when the alarm goes off. It's the worst because you basically have to drop what you're doing (especially annoying when you're in with other patients) to go into that person's room. CRINGE HATE. Just saying.

  16. Steph1:21 PM

    I'm an OR nurse who does night and 24 hour weekend call and I cringe and swear eveytime my phone rings because I know it means I have to come into work. Even though I love my job and know that the surgeries we're doing are emergencies I always feel resentful, especially when it is 3am and I was sleeping. I know I shouldn't feel this way because this is my job and I picked it knowing about call but I'm not sure I will ever stop feeling this way.