DOA

I know it sounds paranoid, but I really think there is a light sensor in my room. If I'm on call, as soon as I turn out the lights, the sensor activates and alerts the ER that an Intensivist is attempting to sleep. This alarm triggers immediate pages and demands that I drive in to the ICU. Sometimes when it's time to sleep, I lay in bed with the lights on and a book on my chest, pretending to be awake, just so they don't call me.

The ICU doc is by nature superstitious. I never, ever, not once, say that the night on call is going well. Such a statement would anger the Gods and bring on several emergent consults. The only time you can say the night went well is the next morning when you're sipping coffee and signing out to the partner taking over.

Against my better judgment, I turned off the lights at around 11:30. They waited about half an hour, just so I could get a taste of deep sleep, and then set off the beeper. There's always the hope that it's just some ward nurse calling with a question, just part of the nightly competition for "Stupidest Nurse Call." This competition is especially acute in the early morning hours when the labs start coming back. I'll answer the page and get "This is Dolores. Bed 17 has a blood pressure of 175/95."

And then silence. You know, I'm supposed to wake up from deep sleep and know not only who's in Bed 17, but what their history is and what the significance of that blood pressure is. Usually I say something like "Well, Delores, can I have some more clues, perhaps even a name?"

Or else they wake you from deep sleep and tell you that Mr. Jones' hemoglobin is 9.7 and yesterday is was 10.0. They drag you out of some wonderful dream and start reciting labs that you'll be reviewing in a few hours on rounds anyway. Here the proper response is "Thanks. I'll alert the media."

Anyway, this was not a nursing call, stupid or otherwise. "5141". The ER. I called in, knowing it was hopeless, I would not be sleeping any time soon. The ER doc answered, and was way too cheerful. "Hey, Thanks for calling back!" ER docs work shifts. When their shift is over they leave. No beeper, no call. Lots of sleep. No wonder they're cheerful.

The patient was an 87 year old nursing home resident. Found unresponsive, brought to the ER by the paramedics. Blood pressure next to nothing, not breathing. The ER doc proudly told me that he had started a central line, volume resuscitated the patient, put her on dopamine to bring up the pressure. He was in the process of getting her intubated and on the ventilator. He then read me her labs: sodium 120, potassium 7.1, pH 6.9, creatinine 4.0....

I interrupted and said : "You know, she sounds sort of... I don't know.... Dead?"

There was that sort of buzz-kill silence and then he rallied his enthusiasm, "Well, as far as we know she's full code."

"Great, I'll be in."

I figured it would be 30 or 40 minutes until they got her up to the ICU, if she lived that long. I lay back down and closed my eyes. The bed shifted and I felt that pressure, air displaced. A soft rasping laugh came from the foot of the bed.

"Please. Spare me the whole Grim Reaper bit."

Air rasping back and forth in the simulacrum of a laugh. A soft voice, inhuman, but almost gentle. "Don't bother going in for this one. I'll have her soon enough."

I sat up and threw the covers back. "You will indeed, but forms must be followed, rituals carried out. " Then a bit of bravado, "You'll get her when I say you get her."

Again the rasping, the settling of robes, creaking of ancient flesh. "I am patient. I have nothing but time."

Then gone. The pressure released and the room empty. I heard the wind whipping the leaves back and forth, the rumble of a distant thunder storm. Stand up, keep moving, brush teeth, keep moving, dress, keep moving.

Into the car and gone.