First Call

As a sub-intern, I am the "first call," which means I'm the first person contacted for anything. The pharmacy pages me when they don't stock the medication I want, the nurses call me if the patient is combative, the consultants let me know what they think. It's great. I feel intimately involved in the patient's care since I'm always first to know what's going on. But it can also be very, very scary. Whenever my pager goes off, I wonder if it could be a potential emergency, and I have to triage requests to decide whether I need my resident to back me up.

My first patient on medicine was a man with acute on chronic pancreatitis. There were some unusual aspects to his presentation with a surprising transaminitis (AST 3000), but one particular incident stands out in my mind. We were sending daily labs and one day the lab pages me with "critical lab values," tests that are so abnormal that the laboratory must call the nurse and MD to confirm we got the results. I was told about a potassium of 2.8 and low calcium, but when I reviewed the lab results, I was shocked to notice a four point hematocrit drop (which wasn't "critical" by lab standards but the most worrisome value for me). The crit drop suggested he was bleeding. I quickly paged my resident and went to see the patient.

The patient was gone. I couldn't find him. I talked to his nurse who said that he left the floor for a cigarette break (despite being counseled to quit smoking and drinking) and had been gone an hour. We overhead paged him and sent someone to look for him, afraid that he was missing with a critical lab value and would be found unconscious somewhere. It was my second day of fourth year and I had lost my patient.

In the end, he returned from his smoking break and the lab values turned out to be spurious (dilution effect because it was drawn from the same arm that was receiving IV fluids). But this was a scary reminder that being first call, I have to be ready for anything.