"What should I call you for?"
This is a common question I get from nurses before I leave their station. They understandably want to know what things are important to me in a given patient's care. Exam changes, abnormal test results, medication problems, etc. I'm fine with answering them, too. It's part of treating someone.
In the early 90's I was an intern, covering the cardiology and general medicine floors. One evening I was meeting with the other interns at a nurses station, getting the nightly check-out. This consisted of them each handing me a crumpled sheet of paper listing patient summaries for me to refer to if called. The lists were folded into a big wad and crammed into my white coat pocket. As I stood up to go see someone in ER, a nurse came over and asked what I wanted to be called on. I absently mumbled "any concerning changes" and stepped into an elevator.
The night ticked on. Several admissions, some calls to discuss labs and medications, the usual smorgasbord of pages. Somewhere after midnight there was a break in the action, and I went to the call room to try and sleep.
I dozed for maybe an hour before the nurse I'd spoken to earlier paged me.
Intern Grumpy: "This is Dr. Grumpy, returning a page."
Nurse Smokey: "Hi, I'm calling you about Mr. Gomer, in room 564. Are you familiar with him?"
Intern Grumpy: "Hang on..."
I switched on the light, grabbed the wad of papers out of my pocket (I still had my coat on) and began flipping through them for room 564.
Nurse Smokey: "No worries, I'll wait."
Intern Grumpy: "Okay, I have him. It says he was admitted for a heart attack 2 days ago, and is scheduled for an angiogram tomorrow."
Nurse Smokey: "Yes, but he has other issues. He also has a history of lung cancer, for which he had surgery and radiation 2 years ago. It recently recurred, and he's now on chemotherapy. There's also him having COPD from being a smoker, and last month he was here for a pulmonary embolism and is on heparin. He needs a left knee replacement, but that's on hold for now due to his other medical issues. Do you need a list of his medications and allergies?"
Intern Grumpy: "No, I have that here... What's going on with him that you're calling?"
Nurse Smokey: "He's on fire."
Intern Grumpy: "WHAT?!!!"
Nurse Smokey: "He's on fire. He's on oxygen, and apparently his wife snuck in some cigarettes and matches and..."
The phone fell to the floor. I ran out of the call room into the stairwell and dropped down 2 flights to the 5th floor. As I flew past the station, Nurse Smokey was still on the phone with my empty call room, calmly saying "Hello? Dr. Grumpy? Can you hear me?"
In room 564 I found Mr. Gomer, miraculously uninjured except for some minor burns and missing eyebrows. He was almost completely covered in ashes and fire extinguisher foam (which a terrified student nurse was still randomly spraying at anything that moved, including me). Another nurse was pulling off the charred oxygen mask and melted tubing, while a respiratory tech made sure all the oxygen valves to the room were closed.
This was a good reason to call the doctor, if not the fire department. Skipping his past medical history, under the circumstances, might have been a good idea, too.
