“Go outside and look at the name of this building,” she snorted. This is Mason Hall. Dr. S shook his head; he’d never heard it called by that name. The pager again: Need admit orders for Mr. D. Who was this patient? He had heard of no admissions to his service today.
Dr. S ran down the stairs—no time to wait for the elevator. The staircase door on 3 was locked. He ran back up to 4, and that one was locked, too. He headed down the stairs. At the bottom a fire door was posted “Do Not Exit. Alarm Will Sound.” He pushed through. There was no alarm, and he found himself standing outside on the back of the building by the loading dock. His pager went off. The text message: Mr. D Needs Lab Orders. Mr. D? Who was this patient?
He made his way to the front of the building, sweating despite the cold temperature. His pager again alerted 67763—a number he recognized: the lab. The lab tech told him that “Mr. L’s K was 6.1.”
“Would the doctor please repeat this?” the tech asked. Dr. S tried to keep his temper. He had heard the result; why should he repeat it? It was policy per the tech. At too loud a voice he shouted, “Mr. L’s K is 6.1” and slammed the phone down in its cradle. He looked up and saw a crowd staring at him, including a small man with a notebook who peered at his ID badge and took notes. It was probably a HIPAA spy.
The lobby was crowded with families waiting for the one slow elevator. He would not risk the stairs again. He squeezed in between an oversize grandmother and a woman with three small but loud children. The doors began to close. Across the hall a man with packages was heading toward the elevator. “Let the doors close,” he prayed silently, “I couldn’t be any later.”
But the grandmother pressed the “door open” button. Floors 1 and 3 were pushed. The man was coming toward the doors. “Hurry up!” Dr. S pleaded to himself.
The man dropped his packages and then slowly picked them up. He walked to the doors and stood there. “I’m going down,” he said. The doors closed. On floor 1 the mother got off and a nurse got on. The nurse stared sullenly at Dr. S and then pressed the button for floor 2.
When the doors opened on 3, Dr. S nearly jumped off the elevator. He hustled down the hallway. Where was room 339? He followed the numbers 311, 313 down the long hallway. At the end of the hall was room 337. There was no room 339. His pager went off again Need orders for CT for Mr. D.
Finally he was back on the ward, logged in on his least favorite computer. On the other hand Mrs. J who had recently had an MI was doing better. He looked at her vitals, her labs. This was the way it was supposed to work. He wanted to start an ACE inhibitor. It was part of the protocol, but she had told him that ACE inhibitors had caused a cough in the past.
He pulled up her allergy list, NKDA. He put in the order for an ARB. A screen popped up: PATIENT POST-MI CONSIDER ACEI. He knew this, but had to use an ARB. He tried to put in the order again, but the pop-up returned. He pulled up the allergy list, and clicked “Update.” He tried to put in “ACEI-induced cough.” The system would not accept it. Then he tried “lisinopril-induced cough.” Again, didn’t work.