While I am examining the tachycardic patient who has a host of medical issues and a curious, but likely, non-surgical problem, I get a little tachycardic myself. She won’t tolerate a surgery, but she is a sick lady. Did I make the right decisions for her? I decide to call the admitting service, to discuss the plan of care, but I realize I don’t know how to reach the admitting physician. Bzzzz…my pager goes off. “Your patient is asleep in OR 19.” Ok. I go to the OR. I walk down one hall. Then another. I loop back. I am lost. Where the heck is OR 19? Bzzzz….”Please call the Transfer Center…”. Sure, I’ll accept her. Sounds reasonable. Admit her to the general med/surg floor. She sounds stable. Found OR 19. Case is straightforward. Thank. God. Ding…text message, just as we are closing. Resident informs me of an “urgent consult” in the ICU. I look up the patient in the computer. Whoa!! He is a sick dude! Labs crazy, off the charts. I pace around the OR, now. Case is over but my mind is with that tachycardic patient. And the ICU guy. I look her up again. Am I missing anything? No, we have a good plan in place for her. But the admitting attending…I want to talk to her. I’ll call the operator and have her paged. Where is the phone? Why isn’t there a phone by the computer? I want a simple bedside test for the ICU guy. How do I get that equipment to the bedside? Grrr…I’ll call for the materials for the test….but I can’t find the dang phone, let alone know which number to call. Crap! I text the resident. Surely, he has done this before and can get the stuff we need to the bedside. I find a phone on the other side of the room. I dial “0”. Nothing. Busy signal. How is the operator not, “0”? How is that not a thing? I ask my resident, “Dude, how do you call the operator?” He rattles off some 5 digit number that will probably take me 3 months and 100s of iterations of mistakes to finally learn. “Cool. Thanks, man.” The admitting attending agrees. We have a good plan. The patient is stable. Bzzz…”Pharmacy: can we change the antibiotics on the patient in Room 6101″? Bzzz…”RN: Pt in room 5756: Hgb dropped to 6.8. Any new orders?” Ding: Text: “Guy in 2745 is hypoxic. Placing on O2.” Bzzz….Ding….Bzzz….Ding. Can you call 9-1-1 from inside the hospital? Is that a thing? Can you just run through the wards, waving the white flag, yelling, “Ok, Emergency General Surgery service, you WIN! You beat me down. You stretched my knowledge and my judgement and my patience and my time. Can I just go home now?”
No. You don’t call 9-1-1. You don’t surrender. You don’t cry. You don’t buckle or crack or go home. You keep pressing on. You keep doing the work you were trained to do. I felt helpless because I am working in a new system where the operator can’t be reached by pressing “0”; where the nurses, and therapists, and pharmacists, and consulting physicians have no clue who I am (I was called Dr. Hartman, Dr. Halloway, Dr. Harway, and Dr. Harwell, today…whatever); where I can’t find the OR, or the bathroom, or the call room, or a cup of hot coffee. But where, after all of that confusion, I did find the ICU, and the sick patient. And his daughter. And I told her how sick her dad was. And that I was so sorry. And that, while I figured out how to order a CT scan for the other hypoxic guy and how to (finally) get a hold of the operator, I couldn’t save her dad. And she melted into my arms. And she cried….and so did I. Because the emergency of the day turned out not to be the operator, or the coffee, or the bathroom, but…that moment. The frustration with the pages and the texts and the consults…just disappeared. And it struck me that, wherever we are, however lost or confused or frantic in the moment, the real emergency might be the family, even more than the patient. The daughter/wife/mother/sister who needs the frank discussion. And the moment of silence, with me just sitting there. And the hand shake/pat on the back/side hug…real hug. The real emergency is the need for human connection. The real emergency is calmed by ignoring the Bzzz…and the Ding…and simply being present with one another. If only for a moment…Disclaimer: My viewpoints are not necessarily reflective of my employer, or any local, regional or national organization that I belong to. As a matter of fact, I pretty much just speak for myself. Please keep that in mind.