July 1st, the first day of internship at Mercy Medical Center in Denver, Colorado, began at 7 am on the run. As I entered the hospital lobby in my brand new, starchy white lab coat, I heard the operators’ steady stream of messages on the overhead pager.

“Doctor Elliott, come to the emergency room. You have a patient.”

“Doctor Elliott, come to the lab.”

“Doctor Elliott, go to room 109 STAT.”

“Doctor Elliott, call the operator.”

I found myself wondering who this Doctor Elliott person was that was so in demand with the same last name as mine. With a startle I realized I was the Doctor Elliott that was being paged. I hadn’t gotten used to my new title yet. But from that moment, I set off running in many directions, propelled by surges of adrenaline.

The overhead pages were incessant with relentless demands for me to be in more than one place at a time. I walked briskly from one task to the next, admitting patients to the hospital from the emergency room, taking histories and doing physical exams, drawing blood, running back and forth to the lab to check results on patients—given that there were no computers available in those days— and checking on patients who were having problems. All the while I tried to act as though I knew what I was doing. It was a long and exhausting day.

By 2 am the following morning, the hospital finally quieted down. No more admissions to the hospital from the emergency room. No more overhead paging for now. The surges of adrenaline began to wear off; I felt drained. It was time to take a break and get a little rest while the opportunity was available.

There were two cots in the hospital call room with a nightstand between them. The rest of the room was bare with no windows, but at two in the morning I didn’t much care. The cot felt soft and irresistible. I reached over to turn out the lamp on the nightstand after assuring myself that I would only close my eyes for a few minutes. Sleep overtook me within seconds.

I dreamed the phone rang. It kept ringing and ringing until it occurred to me that this was not a dream. I groped for the phone in the dark.

“Hello,” I mumbled, not knowing where or who I was. The woman’s voice in the darkness sounded urgent and official.

“The patient in room 232 has a heart rate of 19.”

Trying to sound appropriate, I said, “Gosh, that’s terrible.” There was a silence at the other end while I tried to wake myself and reach for the lamp.

“Well, what do you want to do about it?” the woman’s voice questioned impatiently.

As I started to wake up, I realized this was a very serious, potentially life-threatening matter.

“Call a doctor!” I responded, wishing I hadn’t allowed myself to fall asleep.

“Doctor Elliot, you ARE the doctor,” she said with an edge to her voice.

“I am the doctor? Oh my god.”

I started to hang up the phone, then remembered to say, “I’ll be right there.”

Now I was fully awake, my heart pounding faster than normal. I went to the sink and splashed cold water on my face, threw on my white lab coat, and raced out the door, squinting as my eyes adjusted to the brightly lit hallway.

The call room was on the first floor. The nurse said the patient was in room 232 which meant the second floor. I ran past the elevator to the stairs, thinking it would be faster and hit the second floor running at full speed—until an intrusive thought caused me to shift my pace to almost running in place. What if I get there first before the chief resident or the attending physician arrive? No one will be there to supervise me. I won’t know what to do.

It was the summer of ’83. I had just graduated from medical school a few days before. This was the first day of internship and my first night of taking call and having to be responsible for real patients with only limited supervision. Interns were on the lowest rung of the ladder, like migrant workers with low wages, long hours, and extreme conditions. We averaged about 90 to 100 hours of work per week. Our compensation, beyond our meager salary, was the privilege of entering into the world of professional medicine.

I speeded up my pace again when I spotted a nurse coming in my direction in the otherwise empty hallway.

“Where is my chief resident?” I asked breathlessly.

“He was called to a code blue,” she answered. “He told me to tell you he would be there after he is through with the resuscitation.”

Nurse Susan, the one who called me on the phone, was waiting for me in the patient’s room with her arms folded across her chest. Her name tag was plainly visible on her white starched dress.

“Well, DOCTOR ELLIOTT, what are we going to do?” The sarcasm was dripping from her voice.

Each July the new crop of anxious interns offers the nurses at the teaching hospitals plenty of opportunities to avenge themselves for arrogant treatment they commonly received from the hands of some of the more seasoned doctors.

Trying to ignore the ridicule in her voice, I went over to examine the patient lying motionless in the bed. Her eyes were staring ahead, her skin was pale and clammy, and her lips had a bluish/violet tinge. Her pulse was barely palpable and her blood pressure was non detectable to me. I had never met this person. Miss Trimble was the name on her chart. I didn’t know why she was in the hospital, but it was clear that she needed help fast. Her heart was beating so slowly, it was almost incompatible with life, a condition I knew was called bradycardia.

My mind was in a panic trying to remember what to do for bradycardia. My white lab coat bulged with manuals, reference charts, guides, a reflex hammer, stethoscope, otoscope, and the other paraphernalia that were part of the intern’s uniform. I pulled out my Washington Manual, the intern’s Bible, from a deep side pocket and looked up the treatment for bradycardia. The words in the small print swam before my eyes.

The search for the information was taking too long; we were losing precious moments.

Nurse Susan asked, with a smirk on her face, “Doctor Elliott, have you decided what you want to give the patient?”

Without skipping a beat, I asked, “What would you give the patient if you were the doctor?” At this point the patient’s life was more important than the life of my ego.

She answered, “I would give atropine.”

“That’s what I would give too,” I said.

“How much atropine would you like to give, DOCTOR ELLIOTT?” Nurse Susan seemed to be enjoying herself.

“Well, how much would you give under the circumstances?” I asked, resigned to my foolish position.

“I would start with .5 mg of atropine and then reassess in a few minutes. If her heart rate stays below 40, I would give another .5 mg.” Nurse Susan sounded so professional.

By now I had regained my composure along with my wits and was fully awake. Miss Trimble’s heart rate started to climb until she was out of imminent danger. We had her wheeled to the intensive care unit where she could be monitored closely. On the way there, I pored over her chart to learn more about her medical problems and why she was in the hospital in the first place. She had underlying heart disease and hypertension. Digging through the extensive notes while trying to decipher the illegible handwriting, I saw that one of her doctors had given her an anti-hypertensive medication, a beta blocker, that must have interacted with the medications she was already on and had the effect of blocking down her cardiac conduction system. Apparently the prescribing doctor had not looked carefully at her chart and seen that she was already on a beta blocker.

By morning when I checked on her, Miss Trimble was doing quite well. Her cheeks were pink and she could talk. She remembered very little of the past night and was unclear why she was in the intensive care unit. I told her she had probably been unintentionally overdosed on her medications, the beta blockers, and that the nurse had saved her life.

At 8 am it was time to do morning rounds on the patients. I still had 9 hours to go before I could go home and get some real rest. In those days, interns were required to work all night every third night, in addition to working every day. The 36 hour stretches were brutal, especially for me, ten years older than my classmates.

My fellow interns gathered, eager, anxious, and fresh from a good night of sleep—and fully caffeinated. The chief resident looked bleary eyed from his busy night. Our attending physician, the senior doctor, looking official in his spotless white lab coat, shared his knowledge with us as we went from patient to patient like goslings following mother goose. When we got to Miss Trimble, I made the requisite presentation of her circumstances, telling about her past medical history that I gleaned from her chart, the low heart rate, the atropine, the suspected interaction of her medications, and her current status. The chief resident acknowledged that I had been on my own while he was tied up. The senior physician commended me for a job well done. I clarified to him that it was the nurse who had saved the patient’s life.

At the end of morning rounds, I excused myself for a few minutes and went to the phone to order a big bouquet of flowers for Nurse Susan. On the card, it said, “Thank you, Nurse Susan, for saving the patient’s life. It was a humbling experience for me I’ll never forget. I hope you got some good laughs.”

I took a lot of ribbing from my colleagues over my “Call a doctor” response to the emergency phone call. They heard about it from the nurses, as well as from me. As I passed my colleagues in the hallway, I frequently heard “Call a doctor” followed by bursts of laughter.

Three years later, at the end of my residency in family practice, the training program put on an awards ceremony for the graduating family practitioners. I ended up with a large assortment of awards, including Outstanding Family Practice Resident for the state of Colorado (first time given to a woman) and Most Helpful Resident. In fact, I received 4 out of the 5 awards presented that year. My over-achievement was driven in part by the fear that someone could die because I didn’t have the answer. For years that fear hovered over me like a ghost from that first night of internship, propelling me to go far beyond the call of duty in service to my patients.

The last award of the evening was presented to me by the nursing staff. Of course, the presentation included a re-telling of the “Call a Doctor” incident followed by gales of laughter in the audience. The award from the nurses is framed and hangs on the wall in my office. It says, “Most Congenial Resident of Mercy Medical Center.”