Best phone calls

[Crabbygas]

Things have been a bit slow so I thought I would stir the pot a bit and ask about the best calls folks have gotten. My favorite was from the surgery resident: "I've got a guy in the ER with three gunshot wounds to the head and one to the abdomen. I'm bringing him up for an ex-lap"

---

Members don't see this ad.

 

[ZzzPlz]

Getting ready for some good reading

 

[d9sccr]

Anytime we're called for airway "back-up"

 

[caligas]

3 am from ED:

"patient just arrived from outside hospital. Difficult airway, has a fastrach ETT in. Can you come change the tube out? The outside hospital wants their fastrach tube back"

 

[Airlife91]

A call got routed through to our pre-op holding desk from an angry patient:
- Patient: "why do we HAVE to do general anesthesia for this surgery?!?"
- Me: "the surgeon requires muscle relaxation for this procedure, and thus a GA is required for ventilation, etc"
- Patient: "well I've been doing a lot of research, and there is a new muscle relaxant that doesn't cause respiratory depression"
- Me: SMH.

 

[nimbus]

A call got routed through to our pre-op holding desk from an angry patient:
- Patient: "why do we HAVE to do general anesthesia for this surgery?!?"
- Me: "the surgeon requires muscle relaxation for this procedure, and thus a GA is required for ventilation, etc"
- Patient: "well I've been doing a lot of research, and there is a new muscle relaxant that doesn't cause respiratory depression"
- Me: SMH.

Well if his research says so why don't you know about it dumba**??

 

[teeva]

This is medicine nowadays, the patient gets to order whatever he/she wants, and the patient is always right. So give the patient what he/she wants. New muscle relaxant without general anesthesia.

 

[dhb]

Nurse 1 at 2am: the patients venous blood gas pH is 7.33 is that ok?

Me: wtf are you joking?

Nurse1: mmkay well nurse 2 want's to tell you something

Nurse2: btw my patient has been having a seizure for the past 10min...

Me: WTF!

 

[anbuitachi]

A call got routed through to our pre-op holding desk from an angry patient:
- Patient: "why do we HAVE to do general anesthesia for this surgery?!?"
- Me: "the surgeon requires muscle relaxation for this procedure, and thus a GA is required for ventilation, etc"
- Patient: "well I've been doing a lot of research, and there is a new muscle relaxant that doesn't cause respiratory depression"
- Me: SMH.

Tell the patient to ask the surgeon for some flexiril and proceed to surgery. Anesthesiologist doesn't have to be involved

 

[cchoukal]

I can't remember if I've told this story here before, but I got an awesome nursing call as an intern on cardiology. I had admitted this elderly woman with rapid AFib who had come into the ED with chest pain and palpitations. We started her on some dilt, brought her to the cards floor, and moved on. The call came about 3 in the AM, sound asleep, mind you (rare for an intern on cards), in the Turkish prison that was our call room (imagine a window-less room with 6 bunks, located in a hallway that has the brightest possible fluorescent lights directly above the door so as to blind you as soon as you step out of the pitch black room, where the floors somehow need to be waxed every morning at 4am with the loudest possible 4-wheeled floor-waxing-machine).

Me: Yeah? Cchoukal, returning a page?

Nurse: Are you the intern fro Mrs. Jones?

Me: Yup.

Nurse: Are you aware that she hasn't had a pap smear in quite some time?

Me: Pap smear?

Nurse: Yeah, I was just doing my intake, and noticed that she hadn't had a pap smear.

Me: Intake? She was admitted nearly 8 hours ago? She was admitted for AFib; is this, what is this?

Nurse: It's on the intake form.

Me: I don't understand what this is? Is she stable, is she okay? What's her heart rate?

Nurse: I don't know, I just needed to tell you that she hasn't had a pap smear.

Me: But... I mean, like, does she WANT a pap smear?

Nurse: I don't know.

Me: Okay, then, "MD aware."

I can only assume that I had done something awful to this woman on a previous call night. I can't for the life of me imagine why she'd fell a legitimate need to tell me about a pap smear at 3 in the morning.

 

[pgg]

A call got routed through to our pre-op holding desk from an angry patient:
- Patient: "why do we HAVE to do general anesthesia for this surgery?!?"
- Me: "the surgeon requires muscle relaxation for this procedure, and thus a GA is required for ventilation, etc"
- Patient: "well I've been doing a lot of research, and there is a new muscle relaxant that doesn't cause respiratory depression"
- Me: SMH.

Should have asked him which one. It can be fun to play along.

 

[nycitygas]

"The pics line fell out"

 

[anbuitachi]

"The pics line fell out"

did you tell them to put it back

 

[PTPoeny]

Mature, close to retiring female Nurse: "Teenage boy B is pulling on his penis"

Me: Uh, what would you like to me to do about that? Did you tell him to stop.

Nurse: "I didn't say anything to him but I'm worried he will pull it off Can we sedate him?"

Me: "No sedation. The (male) intern will be right up to tell him to stop it"

 

[WholeLottaGame7]

I can't remember if I've told this story here before, but I got an awesome nursing call as an intern on cardiology. I had admitted this elderly woman with rapid AFib who had come into the ED with chest pain and palpitations. We started her on some dilt, brought her to the cards floor, and moved on. The call came about 3 in the AM, sound asleep, mind you (rare for an intern on cards), in the Turkish prison that was our call room (imagine a window-less room with 6 bunks, located in a hallway that has the brightest possible fluorescent lights directly above the door so as to blind you as soon as you step out of the pitch black room, where the floors somehow need to be waxed every morning at 4am with the loudest possible 4-wheeled floor-waxing-machine).

I'm sure I told this on some other forum, but my favorite "MD aware" story came during intern year, too. Fortunately not at 3AM. Got a page around 11AM or so after we had rounded and I was sitting down to write notes:

Me: Hi, I'm returning a page?
RN: Yes, thank you. Did you happen to examine X this morning?
Me: Uh yes, I examine all my patients, why?
RN: Did you notice anything different today?
Me: Not really, no. Why?
RN: Oh. Well today I heard the heart sounds on the right side...
Me: ....ummm OK?
RN: That is all.

She literally did write "MD aware" w/ re: to that phone call. Should have written it up as a case report of a late-onset dextrocardia in a 55yo.

 

[D P356]

Medicine nights doing cross cover....2am. "Can you put in a diet order for patient B?....oh, and a few other people want to talk to you, here you go................."

 

[Man o War]

I moonlit now and then at this place with the most annoying CRNA on the planet. He would call me every single time the BP was slightly out of range and then would document on the chart "treated/didn't treat BP per Dr Man O war". It was bizarre.

 

[anbuitachi]

I moonlit now and then at this place with the most annoying CRNA on the planet. He would call me every single time the BP was slightly out of range and then would document on the chart "treated/didn't treat BP per Dr Man O war". It was bizarre.

sounds like typical nursing?

 

[WholeLottaGame7]

I moonlit now and then at this place with the most annoying CRNA on the planet. He would call me every single time the BP was slightly out of range and then would document on the chart "treated/didn't treat BP per Dr Man O war". It was bizarre.

Better than the CRNA that doesn't call you when the patient's BP is 70/30 or 210/110...

 

[Man o War]

Better than the CRNA that doesn't call you when the patient's BP is 70/30 or 210/110...

True, but this was horrible. So far the other direction.

 

[chessknt]

At 3am-Doctor a patient with a wristband from the fifth floor is on the opposite side part of the hospital on the eight floor trying to return a patient she mistook for her mother who apparently is on the sixth floor but was actually a patient from the third floor who was reported missing.

Me-wtf?

 

[bigdan]

I've always felt the best calls were those that ended with "Oh. I'm sorry. Wrong number".

While I feel I could type my fingers off on this topic, the most recent frustrating call was at 0100, from one of our busy (and almost-always sensible) cardiologists. I cover attending call from home in one of our Cardiac ICUs.

Cards: Hi Dan. Sorry to bother you. There's a lady at Outside Hospital that I want to run by you. She's 80, completely stable, and came in with dysuria. Found to have UTI. They just called me about new onset Afib. No symptoms, rate less than 100. Do you think I should bring her over?

Me (speaking softly): Uh. Well. If she's stable, we probably don't need to put her in an ICU bed. If she has a UTI, they should probably give her antibiotics. So...

Cards: Yeah. But I think their concern is an 80 y/o can get sick real fast. Plus we'll have to anticoagulate her now, get her an echo, and start new meds for the heart rate.

Me: I agree. But that's floor stuff at worst.

Cards: Okay. It's getting late. I accepted her, and she's in the ambulance on her way over to the unit now.

Me: *stunned silence*
My wife (who I thought was sleeping, yells): If you already accepted her, then why the fu#k did you call?

 

[anbuitachi]

I've always felt the best calls were those that ended with "Oh. I'm sorry. Wrong number".

While I feel I could type my fingers off on this topic, the most recent frustrating call was at 0100, from one of our busy (and almost-always sensible) cardiologists. I cover attending call from home in one of our Cardiac ICUs.

Cards: Hi Dan. Sorry to bother you. There's a lady at Outside Hospital that I want to run by you. She's 80, completely stable, and came in with dysuria. Found to have UTI. They just called me about new onset Afib. No symptoms, rate less than 100. Do you think I should bring her over?

Me (speaking softly): Uh. Well. If she's stable, we probably don't need to put her in an ICU bed. If she has a UTI, they should probably give her antibiotics. So...

Cards: Yeah. But I think their concern is an 80 y/o can get sick real fast. Plus we'll have to anticoagulate her now, get her an echo, and start new meds for the heart rate.

Me: I agree. But that's floor stuff at worst.

Cards: Okay. It's getting late. I accepted her, and she's in the ambulance on her way over to the unit now.

Me: *stunned silence*
My wife (who I thought was sleeping, yells): If you already accepted her, then why the fu#k did you call?

Wow... must have a ton of ICU beds..

 

[Radetzky]

All at 1am in the morning

-Patients with type 2 diabetes says she has had numb feet for several years, please can you come review

-Newly admitted patient wasn't charted her usual evening statin, can you please come chart it so she can have it

-Drain suction is charted in cmH2O, can you please come chart it in mmHg (after finally having nodded off to sleep for 5 minutes)

My personal favourite though on a pager that sometimes cut off ends of words
-Can you please chart some anal

 

[Ipassgas]

Mine was from a CRNA who was on his/her way out.

CRNA: "Dr. Ipassgas, can you come to room 2 when you have a minute?"

Me, figuring I need to sign something, or relieve for a pee break, continue the interview/charting I just started. Around 5 minutes later, I walk into a room with mid fifties male, HR in the low fortys, BP 65/30, sats of 85%, huge ST depressions. I figure treatment has started, so I ask which pressors we're waiting to work, as I fiddle with some vent settings.

CRNA: "I wanted you to see it before I did anything."

Me:

 

[anbuitachi]

Mine was from a CRNA who was on his/her way out.

CRNA: "Dr. Ipassgas, can you come to room 2 when you have a minute?"

Me, figuring I need to sign something, or relieve for a pee break, continue the interview/charting I just started. Around 5 minutes later, I walk into a room with mid fifties male, HR in the low fortys, BP 65/30, sats of 85%, huge ST depressions. I figure treatment has started, so I ask which pressors we're waiting to work, as I fiddle with some vent settings.

CRNA: "I wanted you to see it before I did anything."

Me:

Hey the crna just wanted you to enjoy the view

 

[Iso4ane]

None as exciting whats been mentioned. But, one that will always stick with me.

On night float as an intern at approximately 3-4am.

Nurse: Oh hi Dr 0kazak1, just calling you to tell you that the patient has a temperature of 100.3
*Morning fog: Okay patient has a fever, just give him some...wait*
Me: Could you repeat that for me one more time?
Nurse: Patient has a temperature or 100.3
Me: Is that One hundred and three or One hundred point three?
Nurse: One hundred point three
Me: And what would you like me to do about that?
Nurse: Well, the patient doesn't have a order of Tylenol.
*Okay I may have said this next bit been a little snarky*
Me: I can do that; but I hope you realize that the cut off in our system is 100.4, so it's not like you can even give it at this point.

 

[Ronin786]

My favorite 2 AM page after I finally get some sleep:

 

[anbuitachi]

None as exciting whats been mentioned. But, one that will always stick with me.

On night float as an intern at approximately 3-4am.

Nurse: Oh hi Dr 0kazak1, just calling you to tell you that the patient has a temperature of 100.3
*Morning fog: Okay patient has a fever, just give him some...wait*
Me: Could you repeat that for me one more time?
Nurse: Patient has a temperature or 100.3
Me: Is that One hundred and three or One hundred point three?
Nurse: One hundred point three
Me: And what would you like me to do about that?
Nurse: Well, the patient doesn't have a order of Tylenol.
*Okay I may have said this next bit been a little snarky*
Me: I can do that; but I hope you realize that the cut off in our system is 100.4, so it's not like you can even give it at this point.

Man I been called or paged so many times for a fever in the 99.x

 

[Wolverines83]

Midwife: I don't think the epidural is working for pt x. She's really uncomfortable and writhing in pain. Can you come see her?

Me: sure be right there

Patient is asleep when I walk into the room. It's 3am....

 

[deleted162650]

Not really a phone call, but my favorite request from a surgeon:

"Hey, can you wake him up deep?"



Dude, I know what your asking, but maybe you could go sit in the corner and think about what you just said for a minute - then get back to me once you realize how ******ed that was.

 

[Chip N Sawbones]

None as exciting whats been mentioned. But, one that will always stick with me.

On night float as an intern at approximately 3-4am.

Nurse: Oh hi Dr 0kazak1, just calling you to tell you that the patient has a temperature of 100.3
*Morning fog: Okay patient has a fever, just give him some...wait*
Me: Could you repeat that for me one more time?
Nurse: Patient has a temperature or 100.3
Me: Is that One hundred and three or One hundred point three?
Nurse: One hundred point three
Me: And what would you like me to do about that?
Nurse: Well, the patient doesn't have a order of Tylenol.
*Okay I may have said this next bit been a little snarky*
Me: I can do that; but I hope you realize that the cut off in our system is 100.4, so it's not like you can even give it at this point.

I've been on the other end of that as a med student getting pimped on surgery.

Surgeon: What temperature qualifies as a fever?
Me: A hundred point four.
Surgeon: One hundred point five! You need to go study more!

 

[Iso4ane]

Not really a phone call, but my favorite request from a surgeon:

"Hey, can you wake him up deep?"



Dude, I know what your asking, but maybe you could go sit and the corner and think about what you just said for a minute - then get back to me once you realize how ******ed that was.

I dunno, but are you closing skin first or fascia first?

 

[Iso4ane]

I've been on the other end of that as a med student getting pimped on surgery.

Surgeon: What temperature qualifies as a fever?
Me: A hundred point four.
Surgeon: One hundred point five! You need to go study more!

Well, some define a fever as a temp GREATER THAN 100.4; so if he used that definition, 100.4 wouldn't be a fever.

 

[sigrhoillusion]

Well, some define a fever as a temp GREATER THAN 100.4; so if he used that definition, 100.4 wouldn't be a fever.

Both are wrong. In today's healthcare system, a fever is whenever a patient says they have a fever...

 

[DocVapor]

Last year as an intern, around 2 am, got paged about a middle-aged male s/p L4-5 lami.

Me *groggy*:. Hi, you paged?
RN:. Yes, Mr. X's epidural isn't working anymore and it's sticking out really far can you come look at it.
Me: What do you mean sticking out really far, and I'm not aware of any inpatient epidurals.
RN: it's just sticking way out.
Me:. Fine, be right there.

Walk in the room and pt is chilling sitting up in the chair. I ask the nurse to come in with me. Sit him forward, and what do I see?

The surgical drain tubing.

Quickly I look at the PCA (not the standard yellow color we use for epidural PCA's) and trace the tubing... Directly into his IV.

Me to the nurse:. This isn't an epidural, it's a surgical drain, and his PCA is IV.

Me to patient:. I'm sorry for bothering you sir, if you are having increased pain you should use this button here. If that does not work, please inform the nurse.

Me to nurse:. Sorry, but if his pain is under poor control you'll need to call the surgeon.

Nurse: *deer in headlights*

 

[PonyUp]

Best page I ever received, verbatim: "u r pt is asystole"

No callback number. No room number. No MRN or patient name. Middle of the night on night float.
On night float we carried a ton of teams pagers so I had no idea where to start:

Eventually the nurse paged again with a callback number. It turned out that a patient had been made comfort care during the day and had expired, and they needed me to come declare the patient.

Either way, after receiving the first page I pissed blood for a week, presumably from the incredible speed at which my testicles struck my kidneys [a month into intern year].

 

[dchz]

"Pt has one beat of V tach every 5 mins, please advise"

My least fav ones are where the pt is actually hurt by the action; in icu: "pts pressure is 100/60 I just turned the norepi to 1"

 

[2Fast2Des]

I'm sure I told this on some other forum, but my favorite "MD aware" story came during intern year, too. Fortunately not at 3AM. Got a page around 11AM or so after we had rounded and I was sitting down to write notes:

Me: Hi, I'm returning a page?
RN: Yes, thank you. Did you happen to examine X this morning?
Me: Uh yes, I examine all my patients, why?
RN: Did you notice anything different today?
Me: Not really, no. Why?
RN: Oh. Well today I heard the heart sounds on the right side...
Me: ....ummm OK?
RN: That is all.

She literally did write "MD aware" w/ re: to that phone call. Should have written it up as a case report of a late-onset dextrocardia in a 55yo.

Folks these are the RNs who will soon be administering your anesthetics when they move on from the med surg life

 

[Robotic Wis-Hipple]

"Pt has one beat of V tach every 5 mins, please advise"

My least fav ones are where the pt is actually hurt by the action; in icu: "pts pressure is 100/60 I just turned the norepi to 1"

Very similar thing for me as an intern. Wanted me to write for prn lidocaine to tx asymptomatic intermittent PVCs.

 

[twoliter]

Not really a phone call, but my favorite request from a surgeon:

"Hey, can you wake him up deep?"



Dude, I know what your asking, but maybe you could go sit in the corner and think about what you just said for a minute - then get back to me once you realize how ******ed that was.

I'll be honest, it took me a few seconds to get it.

 

[2Fast2Des]

I had a PACU nurse ask me to come bedside to evaluate a patient who to her she couldn't do her assessment on because she wouldn't respond. Concerned, I rush over making sure she wasn't having some narcotic overdose our PACU nurses induce, I come over, patient is loudly snoring, also happens to be 10pm at night. Who likes being awoken from sound sleep??

Had another call on our pain service at 4am, nurse calls for a patient that had an epidural saying that the patients entire bed is completely soaked and is concerned that it looks like csf. I respond that it's highly unlikely that is the case and asked if the dressing is wet or anything, he says he doesn't know or hasn't looked at it. I told him to turn it off and see if it still continues, but he wants me to come emergently, saying he's a neuro np and moonlights as an rn and that he knows what csf looks like since it had a halo. I come there begrudgingly and look at the epidural and dressing, dry as a desert, and sternly tell him that this is not csf and he would probably have a hell of a headache if the entire bed was soaked from that. Told him to call the gen surg guys and figure out where their drains are probably leaking from. Gotta love these noctors

 

[sanityonleave]

I switched fields into anesthesia so had to repeat a month as an intern during my CA-2 year. I ended up working as the surgical floor intern at one of our community affiliates.

My favorite page during that month while on nights (~1am)--

"wound vac is beeping rm###"

I dutifully went to assess the vac. The bedside nurse came up to me and said "yea I've reinforced it with a bunch of tegaderms but it's still beeping - not sure if you want to change it overnight or what." I looked at the vac (which was, in fact, beeping) and the error message prominently displayed on the front said "High negative pressure / occlusion" or something like that. I unclamped the little plastic clamp over the wound vac line and went back to bed.

On the one hand, at least the nurse tried to troubleshoot the problem on her own -- on the other hand, why not look at the machine first?

 

[PainDrain]

As the CA2/3 on SiCU call you covered the entire ICU and step down while the surgical resident on trauma would be in the OR or ED all night. There were two male nurses who hated anesthesia residents with a passion (rumor was they had wanted to be CRNAs but couldn't cut it). They would call without fail at 330-4am for you to "clean up" the orders of all the ICU patients. "Could you cancel the duplicate order for zofran from a month ago for patient Smith who is intubated and on multiple pressors?" This bulli**** went on and on.

 

[ZzzPlz]

As the CA2/3 on SiCU call you covered the entire ICU and step down while the surgical resident on trauma would be in the OR or ED all night. There were two male nurses who hated anesthesia residents with a passion (rumor was they had wanted to be CRNAs but couldn't cut it). They would call without fail at 330-4am for you to "clean up" the orders of all the ICU patients. "Could you cancel the duplicate order for zofran from a month ago for patient Smith who is intubated and on multiple pressors?" This bulli**** went on and on.

What a load of ****. That shouldn't be tolerated. I would have spoken up to the right people and gotten them canned. And until then I would have ordered ridiculous amounts of mundane nursing jobs for them to do all night. Maybe if you keep them busy enough they won't have time to clean up the orders every night?

 

[Robotic Wis-Hipple]

What a load of ****. That shouldn't be tolerated. I would have spoken up to the right people and gotten them canned. And until then I would have ordered ridiculous amounts of mundane nursing jobs for them to do all night. Maybe if you keep them busy enough they won't have time to clean up the orders every night?

House of God man, House of God. You aren't winning that. You couldn't come up with enough nursing tasks if you tried, and they'd just ignore the orders if you did, you certainly wouldn't do anything that caused them to interact with patients.

It's insane it's gotten to juvenile things like this, but the fact is, there will be nurses that see residents as young inexperienced kids that only play doctor and they resent you for it. But we all also know many good nurses that are worth their weight in gold.

 

[ZzzPlz]

House of God man, House of God. You aren't winning that. You couldn't come up with enough nursing tasks if you tried, and they'd just ignore the orders if you did, you certainly wouldn't do anything that caused them to interact with patients.

It's insane it's gotten to juvenile things like this, but the fact is, there will be nurses that see residents as young inexperienced kids that only play doctor and they resent you for it. But we all also know many good nurses that are worth their weight in gold.

The good news is it gets much better

 

[anbuitachi]

As the CA2/3 on SiCU call you covered the entire ICU and step down while the surgical resident on trauma would be in the OR or ED all night. There were two male nurses who hated anesthesia residents with a passion (rumor was they had wanted to be CRNAs but couldn't cut it). They would call without fail at 330-4am for you to "clean up" the orders of all the ICU patients. "Could you cancel the duplicate order for zofran from a month ago for patient Smith who is intubated and on multiple pressors?" This bulli**** went on and on.

I wouldve just said no. tell the day team

 

[WheezyBaby]

Best page I ever received, verbatim: "u r pt is asystole"

No callback number. No room number. No MRN or patient name. Middle of the night on night float.

 

[Pharmado]

RN pages at 2:00.
Me half-asleep: "Hello, this is the acute pain service I was paged."
RN: "Your pt X needs a new epidural cartridge, can you come change it?"
Me: "How much is left in the cartridge?"
RN: "A little over 100cc."
Me: "The pt won't run out for at least 8 hrs a their set rate. I'll let the day team know."
RN: "Ok thanks."

RN pages at 2:40:
Me seeing the same number: "Hello, I was paged."
RN: "Are you going to come change this cartridge"
Me: "No, when it gets closer to running out you can order a new one from the pharmacy and change it on the floor but it won't run out for 8 hours or more"
RN: "There isn't an order so I can't request a new cartridge. Can I put one under your name."
Me: "Sure, run it at 6/3/20 per the current directions."
RN: "Thanks"

RN pages at 3:15
Me: "I was paged ... again."
RN: "I can't put the order under your name. Please put the order in so I can get another cartridge."
Me: "It has 8 hours left, I'll do it in the morning."
Pause
RN: "So you're not going to put in an order?"
Me: "NO."
RN: "I'll document this in the chart."
Me: "Please don't page me again."