Beepers are instruments of fate.

Sometimes, when I get to do something really great, like put in a line, or scrub into a case, the beeper will be completely silent for exactly the length of time I need, and then go off nonstop for ten minutes when I’m done.

Other times, like today, it’s exactly the opposite. I checked in with my team in the OR, then headed out to see a consult from the ER. On the way, I met another attending setting out to do a fairly large case with only a medical student assisting. He invited me in, but of course I had to go to the ER first. I ran down, thinking, if I do this fast enough, I can get back before he gets very far in the case, and he seemed friendly enough to let me in partway through.

I did that consult in about seven minutes. It wasn’t too complicated, particularly since the ER hadn’t really done a workup yet. I stood by the desk, waiting to tell the ER resident (not one of my favorites) that he could page me again after the CT scan was done, and I would come write the admission orders. I was expecting to see something major on the CT; it turned out not to be there, and I turfed the patient remorselessly to a service much better suited to his needs. And another resident grabbed me: “Alice, you’re with Dr. X, right? I’ve got a patient for you.” [with a sinking heart] “You don’t mean room 17, do you? I just saw her.” “No, I don’t know 17; this is in room 23. . . ” I grit my teeth. Ok, that first one was fast, maybe there’s still hope. This consult took a little longer, but then I was ready to go tell the chief in the OR about their existence, and maybe that other case was only halfway through.

Beep-beep-beep. The floor calling. “Hey, Dr. Alice, your new patient is here in room 9.” [heart falling through the floor] “You mean our post-op patient from this morning, right?” “No, no, this is the transfer that your attending accepted from Little Rural Hospital. Mrs. Harker. You’ll come see her and write orders, right?” At this point I realized I was not fated to get back to the OR, but I was still not a happy camper on the way upstairs. I read myself a riot act, for the fiftieth time this month, on interns not being in the OR. Somebody had to see all these consults and work up the new admission. It was in fact most efficient for me to be the only person running around like crazy. Yes.

I got upstairs, and the nurses all came over with everything that had happened that afternoon while I was off the floor. “Dr. Alice, room 7 has low urine output.” “Dr. Alice, room 11 doesn’t have a ride home.” “Dr. Alice, room 2 is throwing up.” “Dr. Alice, are you going to get that OR consent from room 22?” “Dr. Alice, will you order some more pain meds for room 32?” All at once. The charge nurse must have seen me looking just the tiniest bit frustrated, because she gave me half a chocolate bar, and the world immediately looked much brighter.

Then I was ready to face the family of the new admission, who had clearly been reading one of those horrible books on how to be a patient advocate when your loved one is lost in the murderous jungle of a hospital (where all the nurses are just itching to give incorrect dosages, and the doctors are tripping over each other to make fatal mistakes in their orders). Before I’d even heard the history, they were reading me their laundry list of things I needed to do that night to take good care of the patient. Ahh. Don’t read those books; acting like that just makes your providers very very annoyed.

And in between all this, it seemed as though a very large volume (or perhaps three large volumes) of the hospital’s rules, policies, and regulations, were jumping out of corners in their eagerness to prevent the nurses from taking care of patients. Somehow, every single thing we tried to do on the floor was against some rule, which some administrator only just remembered today. I really hate bureaucrats. This floor is one of the three best in the hospital. The nurses have their faults, but they genuinely care about the patients. People get their pain medications on a fairly regular basis here; they get helped to the bathroom with decent speed; their call buttons are answered almost immediately; their wound dressings are kept neat and dry; abnormal vital signs are noticed fairly rapidly; the nurses’ station is very clean, for a place that’s constantly being used. When patients are transferred here from other floors, they immediately start praising the staff on this unit. But the fact that they’re doing the job well doesn’t prevent the administrators from shoving more and more useless rules at them. It seems like a new poster about “what not to do” shows up every day. I don’t know how they put up with it.

I got half my patients to leave today. I get to sleep for an extra thirty minutes tonight.