Whether it’s my morning off or not, my daughters still have to get to school on time. Accordingly, my alarm clock went off at 6:55 a.m., same as always. I had just gotten home from the hospital about two hours prior, so I spent the next few minutes lurching around the room like an extra from the set of The Walking Dead. Eventually I woke up enough to help the girls with their morning rituals. At 8:15 I walked them to the bus stop. A few minutes later I was waving goodbye as their bus pulled away from the curb. I picked up my usual bagel and coffee at Tim Hortons and drove to the hospital. As I ate in the doctor’s lounge I formulated a battle plan. I would go directly to the medical floor, see my four inpatients as quickly as possible and then beat a hasty retreat home. I figured if I eliminated all nonessential intra-hospital contact I could be back in bed as early as 9:30. That would give me a solid three hours of sleep before my afternoon office began. The plan sounded good, but was it too optimistic? For doctors, sometimes going from Point A to Point B within a hospital is like running a gauntlet – everyone wants to take a whack at you. Nevertheless, I was determined to succeed. Avoid all side skirmishes, I reminded myself as I prepared to exit the lounge.

Beep-beep-beep! I checked my pager’s LCD screen. The number for the medical floor flashed at me ominously. Uh-oh. I picked up the telephone and called.

“Hi Dr. Gray! Just wanted to let you know two of your patients transferred back from St. Elsewhere last night, so we’ll be needing some orders for them.”

“Okay.”

“You should probably have a look at them, too. One of them keeps dumping his pressure and I think the other one’s starting to circle the drain.”

So much for getting home by 9:30.

I headed for my locker, which is located a few steps down the hall from the lounge. I hadn’t made it a third of the way when the nursing supervisor stopped me.

“There’s a problem with that patient of yours who was supposed to go to Timmins for a CT scan of his head today,” she declared. “He’s a DNR, and the other patient he has to share the ambulance with is a full-code.”

She waited for my response. Try as I might, I couldn’t identify the point where these two seemingly unrelated lines of data intersected. Eventually I sighed.

“The suspense is killing me.”

“According to the new EMS policy, they’re not allowed to transport a full-code patient and a no-code patient in the same rig. Two full-codes can share an ambulance, but DNR patients have to be transported by themselves.”

“ What?”

“New policy.”

“Which moron came up with that one?”

“I don’t know, but it means they won’t be able to take your guy.”

“But he already got cancelled once last week due to that blizzard! Besides, he’s perfectly stable. Just because he’s DNR doesn’t mean he’s planning on dying anytime soon. He’s probably less likely to cash out today than I am.”

She smiled wryly and said, “That is exactly what I told the attendants, but they said it didn’t matter – rules are rules. Should we rebook him for next week?”

“Don’t bother. What’s to stop the same thing from happening again next time? Tell you what, let’s temporarily switch him to full code.”

“What do you mean?” she asked.

“Discontinue his DNR order and send him in the ambulance with the other guy. When he gets back from his scan I’ll reinstate his DNR.”

“If central dispatch finds out you’re tweaking DNR orders to facilitate transfers, they’ll go bananas.”

“I’ve got broad shoulders.”

As I was putting on my lab coat one of my colleagues entered the locker room.

“Morning, Donovan! Say, I just noticed that on the new ER schedule you have me on call on the 16th. I won’t be able to work that day – my wife’s parents are going to be in town.”

“You didn’t tell me you weren’t available to work that day,” I whined. Every month I end up revising our call roster six or seven times due to last-minute changes.

“I know, I forgot. Sorry!”

I pulled a copy of the schedule out of my locker.

“Miles is on call the next day. Could you just trade with him?”

“No, that won’t work – the outlaws’ll be staying the entire weekend.”

“Okay, I’ll rework things and get back to you.”

I sat down with the timetable and brainstormed. Five minutes later I had a viable alternative figured out. All right, time to get to work!

I left the locker room and angled across the hallway to our mailboxes. I was glumly eyeing the two new admission cards taped to the front of my box when I heard someone inside the emergency department mention my name.

“… I think I just saw him go by. Maybe he stopped at his mailbox.”

Oh no. Before I could make like Jimmy Hoffa and disappear, one of the ER nurses stepped out into the hallway and collared me.

“Oh, there you are! I have an outpatient sheet from last night that you forgot to sign.”

“Is that all? No problem!” This’ll only take a second!

I trotted over to the main desk and applied my hieroglyphic scrawl to the sheet.

“Oh, and one more thing,” she said. “Remember Mr. Carbuncle? He’s the man who had that nasty abscess on his buttock. You lanced it on Monday.”

“Yes?”

“He’s due to be reassessed this morning to see if his IV antibiotics can be discontinued.”

“That’s nice.”

“He was really hoping you’d be the one to recheck him.”

I was on the verge of deferring the task to the doctor on call when Mr. Carbuncle and his wife both leaned out of the doorway of the nearest treatment room and waved at me cheerily.

“Um, sure, I’d be glad to.”

When I stepped out of the treatment room, the administrative secretary ambushed me.

“Sorry to bother you, Dr. Gray, but we need to schedule a medical advisory committee meeting. There are a number of pressing items on the agenda that need to be addressed.”

“Like what?” Omigod! Wait! Is it too late for me to retract that question?

As she summarized the lengthy list I tried my best to nod at appropriate intervals. When I couldn’t stand it any longer I interrupted her in mid-sentence.

“How about if we have the meeting next Friday at noon?”

“Next Friday at noon sounds great! I’ll send out a memo to everyone.” I turned to go. “By the way,” she said, “The CEO is going to need your help with the upcoming hospital accreditation. Do you think you’ll be able to… .”

Administrative duties fulfilled, I made a beeline for the medical ward. As I was passing switchboard the operator waved me over to her desk.

“That specialist you were trying to track down yesterday is returning your call,” she said.

“Oh, that’s okay – I managed to get the patient I was calling him about stabilized and transferred somewhere else, so I don’t need to speak to him anymore.”

“You might as well tell him that yourself – he’ll be on the line any second now. What number should I put it through to?”

“But – ”

“Here he is now. I’ll patch it through to the phone right behind you in Medical Records.”

Dr. Verbose was in a particularly chatty mood. At his request, we reviewed the details of the case I had been trying to reach him about. He seemed to be satisfied with the way things had turned out. While we were talking I noticed someone from the business office begin to hover nearby. Before long an ER nurse joined her. The instant I hung up they descended like ravens.

“Dr. Gray, the architect wants to know when he’ll be able to meet with you to go over the new medical clinic plans.”

“How about next Friday at noon?”

“Didn’t you just book the next MAC meeting for that time slot?”

“Oh, yeah, that’s right. Okay, make it this coming Monday at 12:30.”

“Super.” She tagged out and the ER nurse took her place.