Being on call stories

[yaah]

Oh I know. I agree. The best way though is to just say no consistently and don't waffle, and force them to go through the lab director or the director of CP, at which point they generally realize it takes less time to just recollect it. Ultimately though if the lab runs a test on a mislabelled specimen it will be the lab that gets sued if the test is wrong, not the person who mislabelled it.

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[AngryTesticle]

Thank god I don't have to do weekend call ever again for the next 7 months. Man, I get paged one more time by the ID team, I'm gonna f*cking punch something. I almost threw my pager against the wall last weekend when I got a page saying, "This is blah blah blah from the ID team..."

MOTHERF*CKERS! I'M NOT YOUR BITCH AND I'M NOT GONNA RUN AROUND CHASING AFTER **** FOR YOU! STOP BOTHERING ME!

"But but you're the on call pathology resident."

"Suck my dick bitch!"

 

[yaah]

I'm already looking forward to tomorrow. We had a lymphoma workup that turns out to be granulomatous inflammation with caseous necrosis and everything. I can already hear the hordes on their way!

I had a pleasant call night last night - only two calls in 24 hours, one was the unlabelled bag of urine and the other was someone who wanted cryo at 11pm.

But yeah, in regards to the ID team, sometimes I just want to say, "Well, special stains have been ordered but they are going to be negative, so don't ask me again tomorrow."

 

[AngryTesticle]

2 more years left...that's all I gots to say.

 

[deschutes]

I have full control of the pager today! I needn't sit around and wait for people to give me things to do - I even got to study some Crush.

Bloodbank is scary. It makes me pager-possessive. I had not thought that would ever be possible.

 

[deschutes]

Five... four... three... two... one... ZERO!!

And the pager is turned off for the weekend!

 

[Whisker Barrel Cortex]

Man, I'm glad you guys aren't doing radiology call or you would probably go postal on someone. Try 40 pages from 8am-noon on a Saturday to start your 24 hour call in which you'll get no sleep. Half the time the intern on the other end doesn't know why they're requesting a study. The other half you wait on hold for the ED attending for 10 minutes trying to give a result. All the while you are getting constant pages. At several points in time, I'm on my cell phone, on hold on another phone, and discussing a case with the trauma team all at once.

So whats my point. Stop whining about friggin platelets! At what platelet level would you consider it safe to stab someones liver multiple times, put a big honkin hole in someones kidney, or put a friggin tube into the femoral artery? Give me a number and some proof about it and I'll give you some credit. If you don't have that number, stop whining and approve the platelets already.

(while this post may come off as angry, the tone should actually be one of playful mocking)

 

[deschutes]

So, they don't have a Being On-Call Stories thread in the Rads forum?

Try 40 pages from 8am-noon on a Saturday to start your 24 hour call

I did get about 40 throughout the day on Tuesday - but I'm only a first-year so lots of time yet to hone my skill level.

At one point (4pm pre-Thanksgiving weekend) I was on the phone to a patient at home who had been D/C'd from hospital that AM. He claimed neither his nurse coordinator or responsible doc had told him what the treatment plan was and was wondering when he was next coming in for apheresis.

Hang up, page responsible doc. Doc calls back, sounds like he's already out of the hospital. "He's on steroids, no plans for pheresis, although I won't be surprised if we have to."

Back to patient, who says he doesn't know anything about steroids, and etc. Well dude, I'm sure your nurse coordinator will tell you when she sees you.

Have I mentioned I love my job? I'm home and pagerless on the day between Thanksgiving and the weekend, FFS.

At what platelet level would you consider it safe to stab someones liver multiple times, put a big honkin hole in someones kidney, or put a friggin tube into the femoral artery? Give me a number and some proof about it and I'll give you some credit.

50K. For all the above. Local institute-wide transfusion guidelines for major invasive surgery/severe active bleeding. Let us know if they continue to bleed.

The guidelines were approved by the transfusion committee (heme-onc, surgery, crit care, anes, peds, medicine, BB MDs, RNs, Pharm Ds, CLS/SBBs).

I think the whinging is because I sometimes feel that blood bank on a day-to-day basis would be most efficiently overseen by a well-organized secretary. The guidelines are all there, the techs know what they're doing (certainly more than the rotating resident who has been there for 1 month does) and they practically run the blood bank anyway.

Just a thought experiment.

 

[yaah]

Man, I'm glad you guys aren't doing radiology call or you would probably go postal on someone. Try 40 pages from 8am-noon on a Saturday to start your 24 hour call in which you'll get no sleep. Half the time the intern on the other end doesn't know why they're requesting a study. The other half you wait on hold for the ED attending for 10 minutes trying to give a result. All the while you are getting constant pages. At several points in time, I'm on my cell phone, on hold on another phone, and discussing a case with the trauma team all at once.

So whats my point. Stop whining about friggin platelets! At what platelet level would you consider it safe to stab someones liver multiple times, put a big honkin hole in someones kidney, or put a friggin tube into the femoral artery? Give me a number and some proof about it and I'll give you some credit. If you don't have that number, stop whining and approve the platelets already.

(while this post may come off as angry, the tone should actually be one of playful mocking)

There are no guidelines.

http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=16217169&query_hl=6

http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=12881779&query_hl=1

Everybody likes to complain. Everyone also likes to say that their field is better or tougher or people don't understand it.

 

[AngryTesticle]

Damn yo...sure puts things in perspective. And here I am getting all worked up about getting paged once!*

*Not including frozen section pages...these I don't mind since I know these pages are inevitable and I'm expecting them.

Man, I'm glad you guys aren't doing radiology call or you would probably go postal on someone. Try 40 pages from 8am-noon on a Saturday to start your 24 hour call in which you'll get no sleep. Half the time the intern on the other end doesn't know why they're requesting a study. The other half you wait on hold for the ED attending for 10 minutes trying to give a result. All the while you are getting constant pages. At several points in time, I'm on my cell phone, on hold on another phone, and discussing a case with the trauma team all at once.

So whats my point. Stop whining about friggin platelets! At what platelet level would you consider it safe to stab someones liver multiple times, put a big honkin hole in someones kidney, or put a friggin tube into the femoral artery? Give me a number and some proof about it and I'll give you some credit. If you don't have that number, stop whining and approve the platelets already.

(while this post may come off as angry, the tone should actually be one of playful mocking)

 

[Whisker Barrel Cortex]

So, they don't have a Being On-Call Stories thread in the Rads forum?

I did get about 40 throughout the day on Tuesday - but I'm only a first-year so lots of time yet to hone my skill level.

At one point (4pm pre-Thanksgiving weekend) I was on the phone to a patient at home who had been D/C'd from hospital that AM. He claimed neither his nurse coordinator or responsible doc had told him what the treatment plan was and was wondering when he was next coming in for apheresis.

Hang up, page responsible doc. Doc calls back, sounds like he's already out of the hospital. "He's on steroids, no plans for pheresis, although I won't be surprised if we have to."

Back to patient, who says he doesn't know anything about steroids, and etc. Well dude, I'm sure your nurse coordinator will tell you when she sees you.

Have I mentioned I love my job? I'm home and pagerless on the day between Thanksgiving and the weekend, FFS.

50K. For all the above. Local institute-wide transfusion guidelines for major invasive surgery/severe active bleeding. Let us know if they continue to bleed.

The guidelines were approved by the transfusion committee (heme-onc, surgery, crit care, anes, peds, medicine, BB MDs, RNs, Pharm Ds, CLS/SBBs).

I think the whinging is because I sometimes feel that blood bank on a day-to-day basis would be most efficiently overseen by a well-organized secretary. The guidelines are all there, the techs know what they're doing (certainly more than the rotating resident who has been there for 1 month does) and they practically run the blood bank anyway.

Just a thought experiment.

I didn't know you guys got that many pages. Yeah, I agree that the stupid clerical stuff that we're required to do takes way too much time and could easily be done by a clerical person.

Again, just a little playful ribbing. Now gimme my platelets.

 

[yaah]

Sorry. No platelets left. They were all given to people with counts of 45,000 who were getting lines pulled. Try back tomorrow!

 

[deschutes]

I didn't know you guys got that many pages.

I have to admit it was an atypical day. We were essentially getting three days' worth of work done in one.

Now gimme my platelets.

Go donate some!

 

[deschutes]

You know, I was wondering about doctors married to doctors and what that meant for call nights.

Let's say the home call schedule is on average one in four. Between the two docs it's going to be one in two.

So every other night you're getting woken up by the sound of the beeper when it's not your night on call.

 

[yaah]

The person on call should sleep in another room, if possible. That would be my solution.

 

[deschutes]

The person on call should sleep in another room, if possible. That would be my solution.

So, sleep apart every other night?

 

[deschutes]

Got called in the middle of dinner on a massive transfusion...

Patient who is new to me came in last night with 90% BSO burns, due for surgery tomorrow.

This afternoon's labs:

HgB 4.5
Plt 30
INR 2.0
PT 20.3
APTT 101.9
Fib 94

Got 3 RBC, 4 FFP, 2 RDU plt (ped dosing is 1 RDU/kg body weight)

3 hours later:
HgB 7.5 (textbook! )
PT 20.4 (rats)
APTT 118.9 (double rats)
Fibrinogen 75
Plt 39K

Gets 4 cryo, 1 FFP, 2 random donor unit (RDU) plts

Repeat plt ct 39K, gets 1U apheresis plts (= 6 RDUs)

2 hours later:
Fib 132
PT 19.2
INR 1.4

So maybe now I can go take a bath.

I never know whether to apologize for waking the attending up...

 

[beary]

So, sleep apart every other night?

This is most definitely what I would do.

 

[yaah]

Got called in the middle of dinner on a massive transfusion...

Sounds like you handled it well. We often don't get called on these situations, as I said. Many surgeons are good at keeping up with products though.

My latest on call adventure was another muscle biopsy - I seem to be the resident who attracts muscle biopsies when on call - this was my 4th of the year so far. It's a good tradeoff, as it is better than being the one who gets lots of frozen sections. I am definitely the one who attracts slow frozen section nights. I also had to deal with a cardiac surgeon who had blasted the blood bank techs over the phone for not giving him platelets before he actually needed them. They had given 6 five packs to this patient in the past 2 hours - #5 and 6 were on the way to the OR when he called and asked for two more. The tech had the audacity to request that he wait until the previous ones were going in to see if he really needed any more, because it is a potential waste of products if they don't actually need them. So I had to be intermediary. Pain in the ass.

 

[AngryTesticle]

Sounds like you handled it well. We often don't get called on these situations, as I said. Many surgeons are good at keeping up with products though.

My latest on call adventure was another muscle biopsy - I seem to be the resident who attracts muscle biopsies when on call - this was my 4th of the year so far. It's a good tradeoff, as it is better than being the one who gets lots of frozen sections. I am definitely the one who attracts slow frozen section nights. I also had to deal with a cardiac surgeon who had blasted the blood bank techs over the phone for not giving him platelets before he actually needed them. They had given 6 five packs to this patient in the past 2 hours - #5 and 6 were on the way to the OR when he called and asked for two more. The tech had the audacity to request that he wait until the previous ones were going in to see if he really needed any more, because it is a potential waste of products if they don't actually need them. So I had to be intermediary. Pain in the ass.

Oh god yaah, is this guy Dr. P*g*ni? I wouldn't be surprised one bit if it was! Oh boy oh boy, there are countless stories of him being a total dingus to med students, scrub nurses, and residents. You really want to avoid crossing paths with that guy! We have a surgeon just like that here...won't mention any names but according to one attending, "he's a total dingus." Fortunately, most of the surgeons at my place and yours too are reasonable and pretty cool.

 

[yaah]

Oh god yaah, is this guy Dr. P*g*ni? I wouldn't be surprised one bit if it was! Oh boy oh boy, there are countless stories of him being a total dingus to med students, scrub nurses, and residents. You really want to avoid crossing paths with that guy! We have a surgeon just like that here...won't mention any names but according to one attending, "he's a total dingus." Fortunately, most of the surgeons at my place and yours too are reasonable and pretty cool.

Uh huh. One of my attendings told me that when he was in med school, this guy was a surgical fellow, and told them all on the first day, "I am the meanest and nastiest fellow in this entire hospital, so you better do what I say." What a ****ing prick to say that, and moreover, to be PROUD of that. I almost wish I had encountered someone like that late in my third year when I knew what I was going into and said in reply, "You know, that isn't something to be proud of," and see how he responds.

 

[AngryTesticle]

Uh huh. One of my attendings told me that when he was in med school, this guy was a surgical fellow, and told them all on the first day, "I am the meanest and nastiest fellow in this entire hospital, so you better do what I say." What a ****ing prick to say that, and moreover, to be PROUD of that. I almost wish I had encountered someone like that late in my third year when I knew what I was going into and said in reply, "You know, that isn't something to be proud of," and see how he responds.

I f*cking knew it! I've heard of this story too actually. Who told you this? The funny thing is that the attending who told you this is probably different from who I heard this from since Dr. dingus Extraordinaire has touched so many lives.

There's this one story of how he was pimping a med student. The girl didn't know the answers so he got all pissy and made her stand in the corner for the remainder of the operation. Heard this from a classmate of hers who was doing the surgery rotation at the same time.

Now, I don't know if this story is true but apparently his scrub nurse asked him during an operation, "Have you always been such an dingus?" OMFG apparently he lost it and ordered her out of the room mid-procedure and said something to the effect of, "You're never scrubbing into any of my procedures ever again...blah blah blah...I have sand in my *****...blah blah blah"

 

[sohsie]

Im not on call now but I had a call forwarded to me from the on call resident. We do specialty signout at my program and I am on the bone/soft tissue service. There is an unfortunate 3 year old with a bladder wall mass that is probably a rhabdomyosarcoma both clinically and histologically, but obviously we need immunos. Since the case got bounced from the GU service to me, the immunos werent ordered until Friday PM, which means that immunos wont come out until Tues PM. The prelim was reported to the 2 physicians on the requisition, but of course no one on the clinical team ever talks to each other, so someone else who is not on the requisition decides they need to know right now. I have no idea who it is but I page her tonight and she calls me back.

I give the prelim and explain that the immunos wont come out until Tuesday PM. She asks will we learn anything more histologically until then. I tell her no. She asked me what immunos I ordered (as if she knows what any of these things are) and I go through them one by one off the top of my head, and she has clearly tuned out. Then she tells me that they scheduled a procedure on Monday and is there any way that they could get it sooner. I then procede to explain in painstaking detail exactly how immunos are performed and how there is no way possible they will come back before Tuesday PM, no matter what (aside from flying around the world really fast or slingshotting past the sun at warp speed or using my tricorder and the guardian of forever etc ... No, I didnt really say that). Then she asked me again if there is any way to get results on Monday as if I had said nothing. I explained it again. Then she said "OK, well if you do have results by Monday, give me a page." I then say (yes I really said this) "Just as if I let go of the pen I am holding in my hand, it will hit the ground every single time no matter what, so too the immunos will not come out until Tuesday PM no matter what." BUt it was clear she thought I was stonewalling her.

After this conversation, I looked up her name to see who she was. She isnt in our directory, but I did a Yahoo search and found out that she used to be a peds heme-onc fellow here (not sure she still is or if she is an attending now). This makes things 10 times worse. This means that she is must have had a lot of interaction with pathology in the past and should know full well how the immunos work here. But I guess for her pathology is just a black box where you put sample in and results come out. And if you kick the box the results come out faster

 

[beary]

But I guess for her pathology is just a black box where you put sample in and results come out.

It seems like lots of med students and residents (and apparently attendings too!) think of pathology this way. I think it is too bad that med students don't get at least a brief exposure to pathology so they have a better understanding of it works, since almost all specialties interact with path. At my school, we have required rotations in everything under the sun (optho, ortho, urology, oto, etc.) but nothing required for path.

 

[CameronFrye]

Im not on call now but I had a call forwarded to me from the on call resident. We do specialty signout at my program and I am on the bone/soft tissue service. There is an unfortunate 3 year old with a bladder wall mass that is probably a rhabdomyosarcoma both clinically and histologically, but obviously we need immunos. Since the case got bounced from the GU service to me, the immunos werent ordered until Friday PM, which means that immunos wont come out until Tues PM. The prelim was reported to the 2 physicians on the requisition, but of course no one on the clinical team ever talks to each other, so someone else who is not on the requisition decides they need to know right now. I have no idea who it is but I page her tonight and she calls me back.

I give the prelim and explain that the immunos wont come out until Tuesday PM. She asks will we learn anything more histologically until then. I tell her no. She asked me what immunos I ordered (as if she knows what any of these things are) and I go through them one by one off the top of my head, and she has clearly tuned out. Then she tells me that they scheduled a procedure on Monday and is there any way that they could get it sooner. I then procede to explain in painstaking detail exactly how immunos are performed and how there is no way possible they will come back before Tuesday PM, no matter what (aside from flying around the world really fast or slingshotting past the sun at warp speed or using my tricorder and the guardian of forever etc ... No, I didnt really say that). Then she asked me again if there is any way to get results on Monday as if I had said nothing. I explained it again. Then she said "OK, well if you do have results by Monday, give me a page." I then say (yes I really said this) "Just as if I let go of the pen I am holding in my hand, it will hit the ground every single time no matter what, so too the immunos will not come out until Tuesday PM no matter what." BUt it was clear she thought I was stonewalling her.

After this conversation, I looked up her name to see who she was. She isnt in our directory, but I did a Yahoo search and found out that she used to be a peds heme-onc fellow here (not sure she still is or if she is an attending now). This makes things 10 times worse. This means that she is must have had a lot of interaction with pathology in the past and should know full well how the immunos work here. But I guess for her pathology is just a black box where you put sample in and results come out. And if you kick the box the results come out faster

Come on. You know that if you stopped sitting around sipping coffee and surfing the internet, you'd be able to get the immunos out quicker. The clinicians have you figured out.

 

[deschutes]

Reading this post I had this random thought about subspecialty surg path - I wonder if the time will come (or if it is already here?) in the practice of pathology where a "patient" will be "buffed" and "turfed" to another service...

Im not on call now but I had a call forwarded to me from the on call resident. We do specialty signout at my program and I am on the bone/soft tissue service.

But I guess for her pathology is just a black box where you put sample in and results come out. And if you kick the box the results come out faster

Yeah, because the practice of pathology is so cush and lifestyle-oriented that we only look at one patient's slide per day - theirs!

 

[deschutes]

Gotta wonder what he's like in his interactions outside of the hospital.

Oh wait, he's a surgeon, there's no such thing as "outside of the hospital".

The funny thing is that the attending who told you this is probably different from who I heard this from since Dr. dingus Extraordinaire has touched so many lives.

 

[deschutes]

Cross-cover resident for same patient decides to order leukoreduced blood for the very first time.

Upshot is that I get called at 3:30am.

Gah.

Now I am really looking forward to my next two weekends free of call!

Got called in the middle of dinner on a massive transfusion...

Patient who is new to me came in last night with 90% BSO burns, due for surgery tomorrow.

 

[AngryTesticle]

Come on. You know that if you stopped sitting around sipping coffee and surfing the internet, you'd be able to get the immunos out quicker. The clinicians have you figured out.

I knew you were probably sarcastic and joking around with this comment. But I have been in sohsie's situation before and it can make you rageful. The sad thing is that clinicians probably see pathologists as lazy and with lots of time on our hands. They probably think that if they badger us over and over again, we would do the immuno's ourselves during the evening so that the results come out one day earlier. I think that's what they want. The reality is, yes I do know how to set up impox reactions and those Dako autostainers. The problem is that I don't know where the different antibodies are being stored and what concentrations, antigen retrival methods, and incubation/wash times for certain antibodies (because for each antibody, these variables can differ!). For me to figure all this out would amount to a fishing expedition. Screw you guys, I'm going home.

 

[AngryTesticle]

Gotta wonder what he's like in his interactions outside of the hospital.

Oh wait, he's a surgeon, there's no such thing as "outside of the hospital".

Actually, outside the surgery setting, he's a reasonable and surprisingly, soft-spoken person. I actually met him at some lab meeting thingy and my first impression of him was that he was a nice guy. But then I heard all these stories from other folks and there was a discrepancy...until I saw the man in action in the hospital.

 

[yaah]

Actually, outside the surgery setting, he's a reasonable and surprisingly, soft-spoken person. I actually met him at some lab meeting thingy and my first impression of him was that he was a nice guy. But then I heard all these stories from other folks and there was a discrepancy...until I saw the man in action in the hospital.

Yeah - he came down for an autopsy on one of his patients and he was very calm, and interesting, and he answered a few of my questions about clinical cardiac issues. I was impressed at the time.


In regards to immunos and the length of time it takes to get something back - here is a sequence of events:

Thursday 3pm: Hemeonc resident calls me and asks if biopsy results are available yet on a patient. When did she have the biopsy? I asked, as I had not heard of this case and had not seen it on the pending list. Supposed to get it today she said. Turns out the biopsy had not even been done yet. I told her that if the biopsy was done before 7 or 8 pm, the slides would be out late the next morning, perhaps not until noon depending on how busy histology was.

Friday 9am: Same resident stops by the lab to ask about this biopsy and if it is back yet. No, I said, Like I said it won't be back until late this morning. I will page you as soon as I know.

Friday 10am: Same resident calls to ask about a different patient and whether we have gotten a chance to review the bone marrow core yet. The bone marrow cores have not come out yet I said. And oh by the way she wanted to remind me to page her when we saw this other biopsy she had asked about.

Friday 11am: I was talking to the office manager for surg path about another issue, and she asked if I was on heme, and I said I was, and she said a resident had called wondering about biopsy results on a patient. Guess which one? At this time I send off a page to the resident which says "I will page you when we have the biopsy."

AAAAAAAAAAHHHHHHHHHH


Here I guess the immuno process is faster - they run them during the day, so if you turn them in before about 8pm they will cut the blanks and deliver them to impox, and impox will run them starting at about 8am. Then they are finished about 3-4pm.

 

[AngryTesticle]

Yeah - he came down for an autopsy on one of his patients and he was very calm, and interesting, and he answered a few of my questions about clinical cardiac issues. I was impressed at the time.


In regards to immunos and the length of time it takes to get something back - here is a sequence of events:

Thursday 3pm: Hemeonc resident calls me and asks if biopsy results are available yet on a patient. When did she have the biopsy? I asked, as I had not heard of this case and had not seen it on the pending list. Supposed to get it today she said. Turns out the biopsy had not even been done yet. I told her that if the biopsy was done before 7 or 8 pm, the slides would be out late the next morning, perhaps not until noon depending on how busy histology was.

Friday 9am: Same resident stops by the lab to ask about this biopsy and if it is back yet. No, I said, Like I said it won't be back until late this morning. I will page you as soon as I know.

Friday 10am: Same resident calls to ask about a different patient and whether we have gotten a chance to review the bone marrow core yet. The bone marrow cores have not come out yet I said. And oh by the way she wanted to remind me to page her when we saw this other biopsy she had asked about.

Friday 11am: I was talking to the office manager for surg path about another issue, and she asked if I was on heme, and I said I was, and she said a resident had called wondering about biopsy results on a patient. Guess which one? At this time I send off a page to the resident which says "I will page you when we have the biopsy."

AAAAAAAAAAHHHHHHHHHH


Here I guess the immuno process is faster - they run them during the day, so if you turn them in before about 8pm they will cut the blanks and deliver them to impox, and impox will run them starting at about 8am. Then they are finished about 3-4pm.

Although these practices are annoying, I can understand why they do this. Think about it. It's all about dispo and I guess you have to see it from their eyes.

Pathology cases:
You hold cases for levels and impox and chasing down consults...and thus, holding a case for an extra day or two can be a real pain in the arse. You can't discharge (aka signout) the case. Meanwhile you have new cases to deal with and work piles up.

Medicine cases:
They want the test results faster because in a few days they will receive new patients. They want to start treatment and get rid of that patients. That's probably why they're so annoying and persistent. Plus, their attendings are probably riding their asses to get this stuff done.

 

[yaah]

Although these practices are annoying, I can understand why they do this. Think about it. It's all about dispo and I guess you have to see it from their eyes.

Pathology cases:
You hold cases for levels and impox and chasing down consults...and thus, holding a case for an extra day or two can be a real pain in the arse. You can't discharge (aka signout) the case. Meanwhile you have new cases to deal with and work piles up.

Medicine cases:
They want the test results faster because in a few days they will receive new patients. They want to start treatment and get rid of that patients. That's probably why they're so annoying and persistent. Plus, their attendings are probably riding their asses to get this stuff done.

I understand too, but the issue is when I tell someone "I will page you when I have the results" that should be the only call I get about it because they should trust me. Unfortunately, they may have to be the squeaky wheel with others who forget or don't get back to them, and I just have to deal with that.

I also had the lovely experience of giving the same diagnosis/results to four different teams of clinicians on one patient's biopsy a couple weeks ago. None of them talked to the other teams. They speak through the chart.

 

[AngryTesticle]

I understand too, but the issue is when I tell someone "I will page you when I have the results" that should be the only call I get about it because they should trust me. Unfortunately, they may have to be the squeaky wheel with others who forget or don't get back to them, and I just have to deal with that.

I also had the lovely experience of giving the same diagnosis/results to four different teams of clinicians on one patient's biopsy a couple weeks ago. None of them talked to the other teams. They speak through the chart.

Oh trust me, I'm not arguing with you.

 

[yaah]

I wish everyone checked their email frequently, that would be a nice way to do it. You just can't tell who are the people who check their email every two days from the people who have it on all the time.

 

[CameronFrye]

I knew you were probably sarcastic and joking around with this comment. But I have been in sohsie's situation before and it can make you rageful. The sad thing is that clinicians probably see pathologists as lazy and with lots of time on our hands. They probably think that if they badger us over and over again, we would do the immuno's ourselves during the evening so that the results come out one day earlier. I think that's what they want. The reality is, yes I do know how to set up impox reactions and those Dako autostainers. The problem is that I don't know where the different antibodies are being stored and what concentrations, antigen retrival methods, and incubation/wash times for certain antibodies (because for each antibody, these variables can differ!). For me to figure all this out would amount to a fishing expedition. Screw you guys, I'm going home.

Oh yeah, I was definitely being sarcastic. Even as a med student, I've been exposed to some of this stuff. People just don't have a good understanding of how path works. Here, neurosurgery residents actually spend 3 months on neuropath (during their research time), so the neuropath team doesn't have to put up with as much of this crap.

 

[cytoborg]

I understand too, but the issue is when I tell someone "I will page you when I have the results" that should be the only call I get about it because they should trust me. Unfortunately, they may have to be the squeaky wheel with others who forget or don't get back to them, and I just have to deal with that.

These squeaky-wheel types inspire such a rage in me that I actually have the perverse desire to toy with them, just to teach them a lesson. I realize most of them are either doing the CYA dance for their seniors or really just are looking out for the best interests of the patient, so I try to be sympathetic, but they manage to get on my very last nerve the way they are so demanding and insinuate that I am not doing my job and just sitting on my ass.

A dermie the other day walzes into the gross room past cut-off time, while I'm frantically slicing and dicing to get everything into the processor, and asks, "Is there any way we can rush this biopsy?" Of course my hackles are all up because first of all, she's a dermie interrupting my cutting ('nuff said) and secondly I heard the word "rush." Mentally, I note that it's an inpatient and it's a Friday and it's not really too far past cut-off time so, being a reasonable person, I decide that yes I will do it for her, but first I'm going to make it seem like a reeeeeeally big favor. I explain sternly that we don't accept specimens past X time, etc etc. but that I'll do it just this once...she was so grateful, it was delicious.

 

[yaah]

New Years Eve and day on call

1) Rush liver biopsy. I had to come in this morning at 9 to process the biopsy and start the processor, then get the histotech in to cut it and the attending in to read it. Ended up being not really a helpful biopsy - no rejection.

2) Odd call from upstate somewhere. An outside hospital is doing an autopsy on a baby who died in bed, they aren't sure whether it is SIDS or the parents rolled over him or what. So they called because they want to know if we have advice on what to look for in a SIDS case since they haven't had one in awhile. My first question to them: Did you call the medical examiner? It should be reported to the medical examiner. Their response: The medical examiner is the one doing the case and is the one with the questions! I gave them the number of our ME and said nothing more.

3) Transfusion reaction on a terminally ill patient receiving platelets. They said she got a fever during transfusion, but wasn't premedicated since she is terminally ill, comfort care only, and can't take medicine by mouth. I wanted to ask, "Then why give her platelets?" I guess they don't want her to bleed to death. But aside from being messy for the nurses and the family watching, is it really a worse way for a terminal disease to end? It's probably not painful.

ALso had a few other calls on platelet issues, and a clinician who wanted pheresis on two patients yesterday morning. I recommend you always check the labs yourself if a clinician calls, requests platelets, and tells you what the lab value was. In this case, they were basing their request on a count done 5 hours earlier which was borderline low for what they were trying to maintain (patient was post op from subdural hematomas). Of course, they neglected to mention that there was a second count done 30 minutes prior, and this was over their "target value."

 

[stormjen]

most of our abnormal requests come from the heme-onc folks who, for some reason or another, have this strange disdain for pathologists. it's like surgeons and internists, only not nearly as severe or as outwardly shown. it's strange. . .

We have this too! It is really obvious at our tumor board. Sometimes they sit there shaking their heads at us.

 

[stormjen]

Sorry. No platelets left. They were all given to people with counts of 45,000 who were getting lines pulled. Try back tomorrow!

This happened to me! At 5:45 a.m. no less, when I wasn't even the one on call! Yet they paged me anyway! Good times!

 

[yaah]

This happened to me! At 5:45 a.m. no less, when I wasn't even the one on call! Yet they paged me anyway! Good times!

I got paged this afternoon by the micro lab, telling me about a positive blood culture - this is something they page the clinicians for. Some ass**** continuously uses his/her horrible penmanship and writes something interpreted as my pager number instead of their own. There are times when this happens on off hours as well. I still haven't figured out who it is. But when I do, you can be assured I will be paging him/her at 3am.

 

[AngryTesticle]

I'm not even on call this weekend and I got paged. Part of this was my fault though. See, I was on call on Friday night which meant that I took the "evening pager" (which is distinct from the weekend pager) that night. Well, I took that pager home with me and it's been at my place the whole weekend because I haven't gone back into work once this weekend. But a few hours ago, some neurosurgeon pages me for a frozen section. I told him that I'm not the weekend call resident. He said, "you're the resident on call." Um no..."you paged the wrong pager number." "So will you be coming into the hospital?" Um no..."you need to call the weekend on-call resident at number xxxxx." Tank you come again. click.

 

[yaah]

Call weekend ended (I thought) with a 4am page for a frozen section liver transplant eval. The donor had crashed her car into an ambulance, interestingly. By the time I got in, did the frozen, got the surg path fellow in (who was covering for attending staff), and we made the dx and I got home it was about 5:30. So I made breakfast and went back to bed, started watching Naked Gun 3 and was planning to just doze off. Pager went off at 6:15. Now there was a request for frozen section eval of a kidney. Different donor - this one died of pneumonia and cerebral edema.

For the renal here there are two options - the rapid processing similar to what happened with the rush liver the day before, which takes about 3 hours total. And doing a frozen for an immediate opinion. Surprise, they chose the frozen even though the surgery wasn't going to be until 2pm, after the liver transplant that they were doing (same surgeon). For that I had to call in the renal path attending - renal and neuropath are their own little worlds, one does not stray in or out except maybe for autopsies. It was not the greatest kidney but they accepted our "mild nephrosclerosis, atrophy, and chronic inflammation" and the surgery will go forth.

Finally got to come home again, by now it is about 8:00, and I am off call.

 

[DarksideAllstar]

Got paged New Years Day by neurosurg telling me they will need a frozen for suspected malignant glioma. This page was about 1:30, said they would be ready around 3:30. I ask for a 30 minute warning. I get the page at 3:00 and they tell me they will be ready at 3:30. I get to the hospital and go down to the OR at 3:30. They tell me it will be a half hour. I go back to the residents room, and come back at 4. Just a couple of minutes more. I chit-chat with the circulating nurse. 20 minutes go by. It will be a few more minutes. 25 minutes go by. I am now talking with anesthesia and looking at the scans wondering why this woman needed such emergent intervention on a Sunday with minimal OR staff specifically for trauma cases. Just a few more minutes. Sitting over at the OR front desk banging my head against the wall. 15 minutes go by. Finally tissue in my hand. 5:15. Squash and frozens done and read. Out at 5:30. Total time wasted: 1 hour 45 minutes.

 

[yaah]

It's amazing how much time is often wasted waiting for frozens. I guess I can understand why surgeons always give us an earlier time than they will actually use, because they don't like to wait for the results and want to get on with the procedure. But I often wonder why there can be such a delay. I had a case on call last month where the case was originally supposed to start at 3pm. At 6pm the neurosurg resident came in and said they were starting now, wanted to make sure someone was around because there was going to be a frozen, and said the specimen would be out in 45 minutes to 1 hr, because the area they were going for was fairly superficial and it wasn't going to take long to get there.

We can access anesthesia op notes online here, so I tracked this patient's progress. Surgical incision didn't occur until 7:30pm - 1 1/2 hours after they said they were starting. We didn't get the biopsy until 10:30pm.

 

[DarksideAllstar]

It's amazing how much time is often wasted waiting for frozens. I guess I can understand why surgeons always give us an earlier time than they will actually use, because they don't like to wait for the results and want to get on with the procedure. But I often wonder why there can be such a delay. I had a case on call last month where the case was originally supposed to start at 3pm. At 6pm the neurosurg resident came in and said they were starting now, wanted to make sure someone was around because there was going to be a frozen, and said the specimen would be out in 45 minutes to 1 hr, because the area they were going for was fairly superficial and it wasn't going to take long to get there.

We can access anesthesia op notes online here, so I tracked this patient's progress. Surgical incision didn't occur until 7:30pm - 1 1/2 hours after they said they were starting. We didn't get the biopsy until 10:30pm.

Indeed, it is quite perplexing. For a fleeting moment I had the feeling that the neurosurgeon in this case and his accomplice thought that we were in house working on a Sunday. But then I realized that if that was the case, they wouldn't have paged me 2 hours prior letting me know that I will have a special "gift" coming my way.

Regarding that frozen, this lesion was superficial as well. It actually occupied a substantial portion of the left frontal cortex and left parietal lobe. Bummer about the whole thing is is that they discovered this when the woman came in on 12/3 with new onset seizures, was in house for like a week, then left AMA. Came in on 12/31 with altered mental status. Guess they figured that they needed to get it done before she woke up, pulled her lines, and bolted for the parking lot. If only they could have gotten into the OR 3 weeks earlier, I would have had a happier New Year.

 

[AngryTesticle]

I'm not even on call this weekend and I got paged. Part of this was my fault though. See, I was on call on Friday night which meant that I took the "evening pager" (which is distinct from the weekend pager) that night. Well, I took that pager home with me and it's been at my place the whole weekend because I haven't gone back into work once this weekend. But a few hours ago, some neurosurgeon pages me for a frozen section. I told him that I'm not the weekend call resident. He said, "you're the resident on call." Um no..."you paged the wrong pager number." "So will you be coming into the hospital?" Um no..."you need to call the weekend on-call resident at number xxxxx." Tank you come again. click.

Well, it happened again.

 

[yaah]

I don't understand - if you didn't bring the pager home then was someone else supposed to come get it? And why isn't there an easy way to find out who is on call? Or is it easy and they just page the same pager because at one time someone wrote it down that way and it has now become policy?

 

[AngryTesticle]

I don't understand - if you didn't bring the pager home then was someone else supposed to come get it? And why isn't there an easy way to find out who is on call? Or is it easy and they just page the same pager because at one time someone wrote it down that way and it has now become policy?

Well yaah, there are actually 3 different pagers for frozen section call:
M-F daytime: 8-5 pm
M-F evening: night time after 5 pm
Weekend: this is the pager to be called from 8 am on Saturday through 8 am on Monday.

I was on call on Friday night which meant that I respond to call from 5 pm Friday to 8 am on Saturday.

I took the M-F evening pager home at 8 pm because I had responded to all the frozen section calls from the ongoing surgeries. However, there could be something that comes up (organ banking or random surgery that happens to come up in the middle of the night). Hence, these calls go to this pager.

The issue is that I got called on Saturday night. This should not have happened. Those calls are in the domain of the weekend person. Now, I could've gone back into the hospital on Saturday morning to return the M-F evening pager but I didn't have to go in on Saturday at all. So, that pager was still in my possession.

Is there an easy way to find out who is on call? Well, the pager number to call is written up on a board in the frozen room. So that should take care of many problem issues that arise. The problem is that some people are ******ed and can't follow directions.

 

[yaah]

I hear that. Ours is listed online or I guess you can get it by calling the operator. We have text paging, which has some good benefits to it, although some are some people who can't figure it out, and spend an extra two minutes using the phone-based paging system even though they are sitting at their computer. Everytime I get a page with only a phone number on it I curse out loud. Every page should include the phone number, who is calling, and why. Not just "x63412 Bill RN"