The Shift

Beep, beep, beep, beep ... ,” the pager sounded. “What time is it?” asked Gregor S. His alarm clock flashed 7:42 a.m. He stumbled across the small apartment, grabbed a warm diet cola out of the grocery sack he had forgotten to unload in last night’s sleep-deprived state. The chicken was ruined, the bologna dubious. The whole bag ditched, save the six-pack.

Gregor went down the stairs two at a time. Mrs. Q with the arthritic boxer in 3G barely let him by, grumbling to herself about young folks today. No time for false pleasantries. He was late again. This would be the third time this month: his first month on staff as a hospitalist. He barely made the 7:52 bus, and was on ward 7 in a quarter of an hour.

At work—more Dr. S than Gregor—he hunted for an open computer. There were three on the ward. The head nurse hovered over a keyboard. Her shoulders were hunched and her body language said “Do not disturb.” Charting vitals or checking her stocks, it did not much matter. She was an immovable object, and he was no irresistible force.

The second keyboard was occupied by Heinrich W, the pharmacist. Dr. S had had a confrontation with the prickly pharmacist over an abbreviation two weeks ago and since then not a word had been spoken between them. Resigned, he approached the third keyboard.

Computer \JFSRVQ289476 was the worst in the entire hospital. The G key stuck and files seem to mysteriously disappear, but Dr. S had no other choice.

He tried to type in his password GREGORS/Hospital but the G button kept on sticking. He shook the keyboard and was ready to punch the monitor. He looked across the ward. The head nurse had left her computer. He got up to move there, but suddenly the G key became unfrozen and Dr. S typed the R and E, but the second G stuck again. He turned to move, but now a surgery resident had logged on to the other computer.

Amazingly, the G key yielded to Dr. S’ heartfelt entreaties, and Gregor signed on. His pager went off at that moment. Text message: Meeting with Committee R at 8:30, Mason Hall room 339. What was this all about? Committee R? What was Committee R? And where was Mason Hall? It was already 8:45 and he had not seen a patient yet. He could not reach the phone from his current position, so he left his seat and crossed the nurses’ station. He called his secretary, but only got her voice mail. He returned to the computer, but it had signed him off. His pager beeped for extension 5-44899. That was too many digits. All the hospital extensions had 5 digits.

He asked the ward clerk where Mason Hall was. She stared at him, chewing her gum and eyeing him like he was a giant cockroach. He turned to the pharmacist who had been watching the exchange, but he quickly turned his head back to the screen and doggedly ignored Dr. S.

Finally the head nurse came by. “Where is Mason Hall?” he pleaded with her. She shook her head at him. What kind of question was this? Why did he want to know where Mason Hall was? He told her about committee R.

“Go outside and look at the name of this building,” she snorted. This is Mason Hall. Dr. S shook his head; he’d never heard it called by that name. The pager again: Need admit orders for Mr. D. Who was this patient? He had heard of no admissions to his service today.

Dr. S ran down the stairs—no time to wait for the elevator. The staircase door on 3 was locked. He ran back up to 4, and that one was locked, too. He headed down the stairs. At the bottom a fire door was posted “Do Not Exit. Alarm Will Sound.” He pushed through. There was no alarm, and he found himself standing outside on the back of the building by the loading dock. His pager went off. The text message: Mr. D Needs Lab Orders. Mr. D? Who was this patient?

He made his way to the front of the building, sweating despite the cold temperature. His pager again alerted 67763—a number he recognized: the lab. The lab tech told him that “Mr. L’s K was 6.1.”

“Would the doctor please repeat this?” the tech asked. Dr. S tried to keep his temper. He had heard the result; why should he repeat it? It was policy per the tech. At too loud a voice he shouted, “Mr. L’s K is 6.1” and slammed the phone down in its cradle. He looked up and saw a crowd staring at him, including a small man with a notebook who peered at his ID badge and took notes. It was probably a HIPAA spy.

The lobby was crowded with families waiting for the one slow elevator. He would not risk the stairs again. He squeezed in between an oversize grandmother and a woman with three small but loud children. The doors began to close. Across the hall a man with packages was heading toward the elevator. “Let the doors close,” he prayed silently, “I couldn’t be any later.”

But the grandmother pressed the “door open” button. Floors 1 and 3 were pushed. The man was coming toward the doors. “Hurry up!” Dr. S pleaded to himself.

The man dropped his packages and then slowly picked them up. He walked to the doors and stood there. “I’m going down,” he said. The doors closed. On floor 1 the mother got off and a nurse got on. The nurse stared sullenly at Dr. S and then pressed the button for floor 2.

When the doors opened on 3, Dr. S nearly jumped off the elevator. He hustled down the hallway. Where was room 339? He followed the numbers 311, 313 down the long hallway. At the end of the hall was room 337. There was no room 339. His pager went off again Need orders for CT for Mr. D.

Finally he was back on the ward, logged in on his least favorite computer. On the other hand Mrs. J who had recently had an MI was doing better. He looked at her vitals, her labs. This was the way it was supposed to work. He wanted to start an ACE inhibitor. It was part of the protocol, but she had told him that ACE inhibitors had caused a cough in the past.

He pulled up her allergy list, NKDA. He put in the order for an ARB. A screen popped up: PATIENT POST-MI CONSIDER ACEI. He knew this, but had to use an ARB. He tried to put in the order again, but the pop-up returned. He pulled up the allergy list, and clicked “Update.” He tried to put in “ACEI-induced cough.” The system would not accept it. Then he tried “lisinopril-induced cough.” Again, didn’t work.

After four more attempts he gave up. He would order the ACEI, and if she coughed they would have to change it. He wrote the order to start low-dose ACEI. A screen popped up: Patient intolerant of ACEIs. Consider ARB. His pager went off again: Mr. D’s family waiting for results.

Dr. S checked his e-mail. There was a reminder not to miss his meeting with Committee R. There was a request from Nigeria from the deposed monarch’s widow for help regaining a vast sum of money, if he would only supply his bank account number; there was also an ad for “VIaGRow.” He searched the hospital database for Committee R, but before he could read the selection his pager went off again for extension 788988.

He called the hospital operator. The phone rang but no one picked up. His pager went off again: Sign discharge summary Mr. D.

The shift was finally over. Dr. S trudged down the hallway. At the nurses’ station there was a beautiful bouquet of flowers. The smell of anaerobes and melena was briefly replaced by the floral scent. As he walked off, the head nurse called to him. “Those are for you,” she mumbled.

“For me?” he wondered. At least someone appreciated his efforts. The annoyances and frustrations of the day seemed to melt away. He read the card: “Thanks for your excellent care. Mr. D and Family.” TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

Beep, beep, beep, beep ... ,” the pager sounded. “What time is it?” asked Gregor S. His alarm clock flashed 7:42 a.m. He stumbled across the small apartment, grabbed a warm diet cola out of the grocery sack he had forgotten to unload in last night’s sleep-deprived state. The chicken was ruined, the bologna dubious. The whole bag ditched, save the six-pack.

Gregor went down the stairs two at a time. Mrs. Q with the arthritic boxer in 3G barely let him by, grumbling to herself about young folks today. No time for false pleasantries. He was late again. This would be the third time this month: his first month on staff as a hospitalist. He barely made the 7:52 bus, and was on ward 7 in a quarter of an hour.

At work—more Dr. S than Gregor—he hunted for an open computer. There were three on the ward. The head nurse hovered over a keyboard. Her shoulders were hunched and her body language said “Do not disturb.” Charting vitals or checking her stocks, it did not much matter. She was an immovable object, and he was no irresistible force.

The second keyboard was occupied by Heinrich W, the pharmacist. Dr. S had had a confrontation with the prickly pharmacist over an abbreviation two weeks ago and since then not a word had been spoken between them. Resigned, he approached the third keyboard.

Computer \JFSRVQ289476 was the worst in the entire hospital. The G key stuck and files seem to mysteriously disappear, but Dr. S had no other choice.

He tried to type in his password GREGORS/Hospital but the G button kept on sticking. He shook the keyboard and was ready to punch the monitor. He looked across the ward. The head nurse had left her computer. He got up to move there, but suddenly the G key became unfrozen and Dr. S typed the R and E, but the second G stuck again. He turned to move, but now a surgery resident had logged on to the other computer.

Amazingly, the G key yielded to Dr. S’ heartfelt entreaties, and Gregor signed on. His pager went off at that moment. Text message: Meeting with Committee R at 8:30, Mason Hall room 339. What was this all about? Committee R? What was Committee R? And where was Mason Hall? It was already 8:45 and he had not seen a patient yet. He could not reach the phone from his current position, so he left his seat and crossed the nurses’ station. He called his secretary, but only got her voice mail. He returned to the computer, but it had signed him off. His pager beeped for extension 5-44899. That was too many digits. All the hospital extensions had 5 digits.

He asked the ward clerk where Mason Hall was. She stared at him, chewing her gum and eyeing him like he was a giant cockroach. He turned to the pharmacist who had been watching the exchange, but he quickly turned his head back to the screen and doggedly ignored Dr. S.

Finally the head nurse came by. “Where is Mason Hall?” he pleaded with her. She shook her head at him. What kind of question was this? Why did he want to know where Mason Hall was? He told her about committee R.

“Go outside and look at the name of this building,” she snorted. This is Mason Hall. Dr. S shook his head; he’d never heard it called by that name. The pager again: Need admit orders for Mr. D. Who was this patient? He had heard of no admissions to his service today.

Dr. S ran down the stairs—no time to wait for the elevator. The staircase door on 3 was locked. He ran back up to 4, and that one was locked, too. He headed down the stairs. At the bottom a fire door was posted “Do Not Exit. Alarm Will Sound.” He pushed through. There was no alarm, and he found himself standing outside on the back of the building by the loading dock. His pager went off. The text message: Mr. D Needs Lab Orders. Mr. D? Who was this patient?

He made his way to the front of the building, sweating despite the cold temperature. His pager again alerted 67763—a number he recognized: the lab. The lab tech told him that “Mr. L’s K was 6.1.”

“Would the doctor please repeat this?” the tech asked. Dr. S tried to keep his temper. He had heard the result; why should he repeat it? It was policy per the tech. At too loud a voice he shouted, “Mr. L’s K is 6.1” and slammed the phone down in its cradle. He looked up and saw a crowd staring at him, including a small man with a notebook who peered at his ID badge and took notes. It was probably a HIPAA spy.

The lobby was crowded with families waiting for the one slow elevator. He would not risk the stairs again. He squeezed in between an oversize grandmother and a woman with three small but loud children. The doors began to close. Across the hall a man with packages was heading toward the elevator. “Let the doors close,” he prayed silently, “I couldn’t be any later.”

But the grandmother pressed the “door open” button. Floors 1 and 3 were pushed. The man was coming toward the doors. “Hurry up!” Dr. S pleaded to himself.

The man dropped his packages and then slowly picked them up. He walked to the doors and stood there. “I’m going down,” he said. The doors closed. On floor 1 the mother got off and a nurse got on. The nurse stared sullenly at Dr. S and then pressed the button for floor 2.

When the doors opened on 3, Dr. S nearly jumped off the elevator. He hustled down the hallway. Where was room 339? He followed the numbers 311, 313 down the long hallway. At the end of the hall was room 337. There was no room 339. His pager went off again Need orders for CT for Mr. D.

Finally he was back on the ward, logged in on his least favorite computer. On the other hand Mrs. J who had recently had an MI was doing better. He looked at her vitals, her labs. This was the way it was supposed to work. He wanted to start an ACE inhibitor. It was part of the protocol, but she had told him that ACE inhibitors had caused a cough in the past.

He pulled up her allergy list, NKDA. He put in the order for an ARB. A screen popped up: PATIENT POST-MI CONSIDER ACEI. He knew this, but had to use an ARB. He tried to put in the order again, but the pop-up returned. He pulled up the allergy list, and clicked “Update.” He tried to put in “ACEI-induced cough.” The system would not accept it. Then he tried “lisinopril-induced cough.” Again, didn’t work.

After four more attempts he gave up. He would order the ACEI, and if she coughed they would have to change it. He wrote the order to start low-dose ACEI. A screen popped up: Patient intolerant of ACEIs. Consider ARB. His pager went off again: Mr. D’s family waiting for results.

Dr. S checked his e-mail. There was a reminder not to miss his meeting with Committee R. There was a request from Nigeria from the deposed monarch’s widow for help regaining a vast sum of money, if he would only supply his bank account number; there was also an ad for “VIaGRow.” He searched the hospital database for Committee R, but before he could read the selection his pager went off again for extension 788988.

He called the hospital operator. The phone rang but no one picked up. His pager went off again: Sign discharge summary Mr. D.

The shift was finally over. Dr. S trudged down the hallway. At the nurses’ station there was a beautiful bouquet of flowers. The smell of anaerobes and melena was briefly replaced by the floral scent. As he walked off, the head nurse called to him. “Those are for you,” she mumbled.

“For me?” he wondered. At least someone appreciated his efforts. The annoyances and frustrations of the day seemed to melt away. He read the card: “Thanks for your excellent care. Mr. D and Family.” TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

Beep, beep, beep, beep ... ,” the pager sounded. “What time is it?” asked Gregor S. His alarm clock flashed 7:42 a.m. He stumbled across the small apartment, grabbed a warm diet cola out of the grocery sack he had forgotten to unload in last night’s sleep-deprived state. The chicken was ruined, the bologna dubious. The whole bag ditched, save the six-pack.

Gregor went down the stairs two at a time. Mrs. Q with the arthritic boxer in 3G barely let him by, grumbling to herself about young folks today. No time for false pleasantries. He was late again. This would be the third time this month: his first month on staff as a hospitalist. He barely made the 7:52 bus, and was on ward 7 in a quarter of an hour.

At work—more Dr. S than Gregor—he hunted for an open computer. There were three on the ward. The head nurse hovered over a keyboard. Her shoulders were hunched and her body language said “Do not disturb.” Charting vitals or checking her stocks, it did not much matter. She was an immovable object, and he was no irresistible force.

The second keyboard was occupied by Heinrich W, the pharmacist. Dr. S had had a confrontation with the prickly pharmacist over an abbreviation two weeks ago and since then not a word had been spoken between them. Resigned, he approached the third keyboard.

Computer \JFSRVQ289476 was the worst in the entire hospital. The G key stuck and files seem to mysteriously disappear, but Dr. S had no other choice.

He tried to type in his password GREGORS/Hospital but the G button kept on sticking. He shook the keyboard and was ready to punch the monitor. He looked across the ward. The head nurse had left her computer. He got up to move there, but suddenly the G key became unfrozen and Dr. S typed the R and E, but the second G stuck again. He turned to move, but now a surgery resident had logged on to the other computer.

Amazingly, the G key yielded to Dr. S’ heartfelt entreaties, and Gregor signed on. His pager went off at that moment. Text message: Meeting with Committee R at 8:30, Mason Hall room 339. What was this all about? Committee R? What was Committee R? And where was Mason Hall? It was already 8:45 and he had not seen a patient yet. He could not reach the phone from his current position, so he left his seat and crossed the nurses’ station. He called his secretary, but only got her voice mail. He returned to the computer, but it had signed him off. His pager beeped for extension 5-44899. That was too many digits. All the hospital extensions had 5 digits.

He asked the ward clerk where Mason Hall was. She stared at him, chewing her gum and eyeing him like he was a giant cockroach. He turned to the pharmacist who had been watching the exchange, but he quickly turned his head back to the screen and doggedly ignored Dr. S.

Finally the head nurse came by. “Where is Mason Hall?” he pleaded with her. She shook her head at him. What kind of question was this? Why did he want to know where Mason Hall was? He told her about committee R.

“Go outside and look at the name of this building,” she snorted. This is Mason Hall. Dr. S shook his head; he’d never heard it called by that name. The pager again: Need admit orders for Mr. D. Who was this patient? He had heard of no admissions to his service today.

Dr. S ran down the stairs—no time to wait for the elevator. The staircase door on 3 was locked. He ran back up to 4, and that one was locked, too. He headed down the stairs. At the bottom a fire door was posted “Do Not Exit. Alarm Will Sound.” He pushed through. There was no alarm, and he found himself standing outside on the back of the building by the loading dock. His pager went off. The text message: Mr. D Needs Lab Orders. Mr. D? Who was this patient?

He made his way to the front of the building, sweating despite the cold temperature. His pager again alerted 67763—a number he recognized: the lab. The lab tech told him that “Mr. L’s K was 6.1.”

“Would the doctor please repeat this?” the tech asked. Dr. S tried to keep his temper. He had heard the result; why should he repeat it? It was policy per the tech. At too loud a voice he shouted, “Mr. L’s K is 6.1” and slammed the phone down in its cradle. He looked up and saw a crowd staring at him, including a small man with a notebook who peered at his ID badge and took notes. It was probably a HIPAA spy.

The lobby was crowded with families waiting for the one slow elevator. He would not risk the stairs again. He squeezed in between an oversize grandmother and a woman with three small but loud children. The doors began to close. Across the hall a man with packages was heading toward the elevator. “Let the doors close,” he prayed silently, “I couldn’t be any later.”

But the grandmother pressed the “door open” button. Floors 1 and 3 were pushed. The man was coming toward the doors. “Hurry up!” Dr. S pleaded to himself.

The man dropped his packages and then slowly picked them up. He walked to the doors and stood there. “I’m going down,” he said. The doors closed. On floor 1 the mother got off and a nurse got on. The nurse stared sullenly at Dr. S and then pressed the button for floor 2.

When the doors opened on 3, Dr. S nearly jumped off the elevator. He hustled down the hallway. Where was room 339? He followed the numbers 311, 313 down the long hallway. At the end of the hall was room 337. There was no room 339. His pager went off again Need orders for CT for Mr. D.

Finally he was back on the ward, logged in on his least favorite computer. On the other hand Mrs. J who had recently had an MI was doing better. He looked at her vitals, her labs. This was the way it was supposed to work. He wanted to start an ACE inhibitor. It was part of the protocol, but she had told him that ACE inhibitors had caused a cough in the past.

He pulled up her allergy list, NKDA. He put in the order for an ARB. A screen popped up: PATIENT POST-MI CONSIDER ACEI. He knew this, but had to use an ARB. He tried to put in the order again, but the pop-up returned. He pulled up the allergy list, and clicked “Update.” He tried to put in “ACEI-induced cough.” The system would not accept it. Then he tried “lisinopril-induced cough.” Again, didn’t work.

After four more attempts he gave up. He would order the ACEI, and if she coughed they would have to change it. He wrote the order to start low-dose ACEI. A screen popped up: Patient intolerant of ACEIs. Consider ARB. His pager went off again: Mr. D’s family waiting for results.

Dr. S checked his e-mail. There was a reminder not to miss his meeting with Committee R. There was a request from Nigeria from the deposed monarch’s widow for help regaining a vast sum of money, if he would only supply his bank account number; there was also an ad for “VIaGRow.” He searched the hospital database for Committee R, but before he could read the selection his pager went off again for extension 788988.

He called the hospital operator. The phone rang but no one picked up. His pager went off again: Sign discharge summary Mr. D.

The shift was finally over. Dr. S trudged down the hallway. At the nurses’ station there was a beautiful bouquet of flowers. The smell of anaerobes and melena was briefly replaced by the floral scent. As he walked off, the head nurse called to him. “Those are for you,” she mumbled.

“For me?” he wondered. At least someone appreciated his efforts. The annoyances and frustrations of the day seemed to melt away. He read the card: “Thanks for your excellent care. Mr. D and Family.” TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.