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The final page

From the December ACP Hospitalist, copyright © 2008 by the American College of Physicians

By James S. Newman, FACP

August 1984. I will never forget my first pager. It was large and bulky and hung lopsidedly off my belt, but I was proud to wear it. It made me feel like I was a doctor, though I was still a medical student. Yes, in the Year of Big Brother I accepted the tether gladly, not knowing it would soon become my nemesis.

January 1985. As a senior student, when my pager beeped I had to call the switchboard for my message. Sometimes it would not go off for days on end, so I would page myself to make sure it worked, concocting interesting messages for the operator to give me. I suspected it was a great “chick magnet,” but there must have been some form of electromechanical distortion with my own magnetism, since I was generally dateless and certainly clueless.

On my last night on service, our team was post-call and all was quiet on the hospital front. I had a fun evening planned with a lascivious medical records clerk. As I walked up the sidewalk to her apartment, the pager began squawking merrily. My resident had a case he wanted me to work up—a great murmur to hear. I trudged to the hospital with a mixture of excitement and despair, and arrived to find the patient had left AMA. When I returned to my date’s apartment, she was AMA as well.

July 1986. I began to loathe my chirping companion in earnest. Without fail, as I drifted off to sleep in the call room, the insistent beeping dragged me from the sweet arms of Morpheus into a hypertensive crisis or an impacted colon. There was no distinction between unnecessary and emergency when the tone sounded. Either way, my REM was off the rails.

October 1988. As a resident, I began the year at peace with my new model pager: It was smaller, it vibrated and it had a text feature. But the honeymoon was over when I added a second, then a third pager to my belt while I rotated through the ICU; I was now carrying my personal pager, the ICU pager, and the code beeper. Adding my stethoscope, a hammer best used for opening beer bottles, and a handy pack of K-Y gel, gloves and Guaiac cards, I felt like a demented Batman with a cacophonic utility belt. It took years for my sleep cycle to recover, only to be thrown into permanent disarray by my procreation efforts (which bore fruit despite “pagus interruptus.”)

March 1994. As a private practice consultant, my pager became my leash. Wherever I went, whatever I was doing, the pager was there to pull me from my life into someone else’s. Sometimes the calls were valid; other times they were dubious. Occasionally they rescued me from a boring meeting.

December 2001. On my last day in private practice, I bid a fond farewell to many of my long term patients, and good riddance to others (for whom the feeling was likely mutual.) As I walked out the door, the dreaded tone sounded, spoiling my exit. I was needed back in the exam room, where my patient had one more question about the chest pain he’d been having. One hour, an EKG, blood work and an ambulance ride later, he was in safe hands, and I was finally free to leave.

January 2002. I became a hospitalist. My pager was still a tether, but one I only had to wear on duty. On non-clinical days, I found myself wandering through my life amazed to be unencumbered. Then my kids learned how to page me.

November 2008. I had a dream. It was decades in the future, on my last day of work before retirement. I walked into the communication center, ready to turn in my pager. I reached for the on/off button—expecting it to beep one last time for some dire emergency or frivolous question, for a call from my secretary or a complaint from a student … but no pages came. Complete silence. I handed in the hated box and was free.

It seemed like a dream, and it was. I charged up the stairs unencumbered, but suddenly felt a crushing sensation in my chest. It was the proverbial elephant standing there. I crawled out of the stairway into the hallway, and heard the code called. The ICU resident came running down the hallway, his breakfast left behind, his pager in hand.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated