Day (or night) in the life of a nocturnist

Ahh the sunny beaches of Seychelles. Why did I wait so long to get here? (buzz buzz buzz) Is that a fly? Surely, not here. Not on this pristine slice of beautiful Earth. (buzz buzz buzz) Dangit, fly??!! Ohh wait is that my pager? Is that the General Internal Medicine Triage Officer (GIMTO) sending me another patient? A nurse who is asking for a sleeping pill? Pain medicine that should have already been ordered? (buzz buzz) Ahh, it was only my cell phone. 2:00pm and I am still at home. Time to wake up and eat cereal.

Boy I love driving to the hospital at 4:30pm. Everyone else is trying to drive away. No rush trying to find a parking spot. What service am I working again today? Admitting would be sweet. No cross-cover, just me and my ideas on how to care for patients. Not having to worry about anyone else forgetting pain meds, zofran, or colace. Pulmonary is usually pretty nice, unless a patient goes downhill. Then, one hour of my night disappears with them. The non-teaching general internal medicine (GIM) pager has been hit or miss. Lately, the service is ballooning to 60 patients. Good for the hospital, bad for shotgun pages at 6:00pm, 10:00pm, and 4:00am. I sometimes wonder why we get 20-30 pages between 5:30 to 7:30pm. It’s an exercise in efficiency and Zen. Lastly, Kaiser, Bone Marrow, Pall Med, GI and whatever other service decides to utilize us. This pager has not been too bad in the last month. Bone Marrow seems to be coordinating their calls more often and the fellows and PAs appear to remember to adjust pain meds. I wish they would have pre-orders for fever though.

Ahh, I get to carry the GIM pager. I wonder how many pages I am going to get tonight asking if I cover GIMTO patients. Do they not realize those two little letters mean so much? (buzz buzz buzz) The first barrage of pages, and of course all the teams have signed out by 5:15pm. This patient is agitated, in restraints, and no haldol prn? The patient got switched to percocet at 3:00pm and already wants their dilaudid? A family meeting now? (buzz) First admission from the Emergency Department (ED). Nice to see they are cleaning house. Time to go to the ED. (buzz buzz) Do I know if the patient will go home tomorrow? Maybe, though I will not decide. Yes, the patient can have an extra dose of dilaudid and benadryl. Why is she not on a patient-controlled analgesia (PCA) pump? Need to transfer her to GIM 3. Well, done admitting that 90 year old for altered mental status and a history of metastatic pancreatic cancer on tube feeds and severe dementia. The only person I could contact was her granddaughter who firmly believes the patient would want everything done... ok.

It is about 8:00pm. Time to eat dinner. Normally, I would bring a few sandwiches, but tonight I will make a McDonald’s run. (buzz) A sleeping pill at 9:00pm? Sure. Dinner time is usually interesting depending on who is around. Lowell is probably one of the best Asian chefs in the hospital. Another colleague always has some interesting pita sandwiches filled with Middle Eastern delights.

I’ve got some time to review cross-coverage sign out. Let’s see only 7 subspecialties notes to review, 6 BMPs, 5 chest… x… rays. 4 hemoglobins, 3 cardiac enzymes, 2 line placements, and a restraint order to be signed at 4:00am. (Using the tune from the Twelve Days of Christmas)

(buzz) You called an AMET on chest pain? Are the vitals stable… yes? Ok, I guess. I will be right there. Stat EKG, enzymes, CXR, and nitro. The patient is fine after the nitro? Let us see how the enzymes turn out.

The midnight hour approaches. 2 hours later, oh there are the stat cardiac enzymes which are negative. Should I go to the call room now, or wait for my next admission? Admitting and Kaiser still are waiting. (buzz) Am I Orange? Not since last year. Also, why does the GIM pager always get paged when Orange is asked for? No, I do not cover Kaiser. No, I do not distribute admissions, call the GIMTO.

Let us see, it is 1:30am. I wonder if I will get 3 hours of sleep. (buzz) Another patient who can not sleep? Why do they not put ambien in the water? (sleep… buzz) Yes, did someone page GIM? General Internal Medicine? (hold) No one paged me? Ok… did anyone page anyone? Yes… yes, you can give an extra dose of dilaudid.

As I nod of to sleep again, I think about all of the flexibility this job offers. I must have spent half the months of February thru April in airports while on the interview trail. Due to the great flexibility offered in scheduling shifts, by the month of May I had caught back up in work hours. I wonder how many other staff could pull that off, at least those without Audi A8s. I wonder if I’ll ever buy an Audi A8. I wonder if the chairman will ever get one. Why have I spent the last 30 minutes thinking about cars?

Time to catch some more Zzzzzzs. (sleep… … buzz) Am I covering H81-12? I don’t know. Who is the staff? Dr.? He is the GIMTO right now, not the staff. Who wrote the last note? Yes, the last primary team note in Epic. You don’t know? Look in the computer? You are not near a computer? Ok... I’ll wait. It’s Tucker? Try calling them.

(buzz) Constipation? How long has this been going on? It’s 5:00am? He’s had it for 3 days? Sure, I guess the colace will help. (buzz) The patient lost IV access. How many times have you tried? Has another nurse tried? Another nurse? Any important medications needed? Ok, wait for SWAT. (buzz) The patient is confused? I think I’m confused. Reorient. It’s 6:30am. Time to get up and make sure my patients did ok. Only paged every 30 minutes since 1:00am.

Hmm… do I want to page the GI fellow at 7:00 or 7:15am. Signout to pall med went fairly smoothly. It’s time to go home. I wonder if my driving is worse than a blood alcohol level greater than 0.1. Finally, I arrive home to my bed. I’m glad I have a four day weekend to look forward to. I can’t wait for some rest and relaxation. Five hours of sleep in the daytime, then trying for seven hours of sleep tonight. This job does have its benefits. Even if I have two tough shifts a week, I still have the weekend to recover. It seems like many colleagues are able to spend plentiful times with their families. The combination of salary, benefits, and free time is tough to beat. Plus, my pager will spend the next few days off.

Speaking of time off, visions of the beach are entering my consciousness. Hear the waves softly crashing against the shore. That sure is nice music in the background. The world is slowly fading away. Wait a second. What is that I hear? (buzz… buzz… buzz)