Anonymous Doctor

So the "rapid response" alarm went off this morning-- my first time involved with this-- I'd just figured every alarm was a code situation, but apparently there's distinctions. They call rapid response when a patient falls, or faints, or needs some sort of immediate help but not CPR, basically. So the alarm went off during rounds, we asked the attending if we should go, and he said no, it's fine, someone else will deal with it. Five minutes later, we hear the code alarm over the loudspeaker, and so we all go running. Turns out it wasn't a code. It was just this patient who fell. The nurse rang the code alarm because no one responded to "rapid response."

I can't figure out which is the bigger problem: no one responds to "rapid response," because everyone assumes someone else will respond and since it isn't the highest-level emergency, no one feels terribly compelled to interrupt whatever they're doing-- or that the solution to this is to fake a code, so everyone does come running... but then feels duped. I mean, the scary thing is that the next time there's a code, there's going to be some doubt that maybe it's not a code, maybe they just want someone to come running. And maybe it's for something someone should come running for, but still. It's like The Boy Who Cried Code. You fake a code enough times and when there's a real code, no one's going to care and the patient's going to die.

But at the same time, I don't know if it's really fair to blame the nurses for faking the alarm-- the rapid response team should be responding when the alarm goes off. Or they should change the system to something that makes sense, whatever that might be. Hopefully something with more clarity than the terror alert color scheme. Because clearly if they have to fake codes, something's not working. The attending who told us not to go to the rapid response wasn't acting maliciously-- he didn't want anything bad to happen to the patient who needed help-- but he'd just seen too many "rapid responses" that didn't need a response at all, so he figured we didn't need to bother. But if that's what happens, then maybe it's the rapid response threshold that's the problem.

The fire alarm went off too, and everyone completely ignored it. "Not a code, don't worry," my resident said. But if it's a fire---- I guess everyone assumes it's not going to be a fire. Although there was a hospital fire in the news earlier this year, so it's not completely impossible. So we have the fire alarm and the rapid response alarm, both of which everyone ignores-- what if it's a patient that's on fire. Is that the fire alarm, or the rapid response alarm, and even if both of them go off, what if no one bothers to go find out what the problem is?

Thing is, codes are sexy, if that makes any sense. In a weird way, I've seen a lot of my colleagues get really excited when there's a code, they get to use the defibrillator, they get to potentially save a life. Picking someone up off the ground-- not sexy. So in a way I get why the code alarm has people running from across the hospital to get there and the rapid response alarm doesn't. But it doesn't actually make sense. There's lives at stake, and more than just theoretically.

It's much too easy to see why no one goes into general practice. General practice is the rapid (or not so rapid) response, as opposed to the specialties being the codes. The specialists get to solve the sexy problems, and general practitioners get to help people manage their diabetes. Not sexy.

Everyone had been saying working every 4th night overnight isn't so bad, but, man, I take back any complaints about staying late on the day shift. At least on the day shift you get to sleep in your bed at night. I'm still exhausted from the other night, and by the time my body re-adjusts, it's going to be Saturday and I'll be on call overnight again and screw my system right back up. I'm not someone who can thrive on 4 hours of sleep. I love sleep. I sleep well, and often. I don't have a lot in my life-- no girlfriend, not enough friends, no hobbies to speak of, this blog I suppose, a few too many video games, a basically-empty refrigerator-- sleep is one of my few highlights. And I hate that they're taking it away from me. I hate it.