MARIETTA, GA – “It was time,” explained hospitalist James Smith as he caressed his American Messaging pager circa 1981 with its screen reminiscent of a jaundiced Gameboy. “It was time.” Though it took some time, Smith finally made the difficult but easy decision of making his pager both a DNR and unavailable (forever).
Smith’s pager has been in decline over the past few years. He has witnessed generalized tonic-clonic pages, sometimes with chirps and other times with vibrations, progressing to the point of hyperthermia and status interrupticus. He has seen numerous episodes of altered mental status where the pager would flash incomprehensible gibberish, often referred to as hieroglyphics mode. “I remember when I would receive actual callback numbers,” said Smith. “But just look at this page I received yesterday. It reads %&*///OO#@#%^&/<.”
Most recently, Smith’s pager has become increasingly agitated instead of pleasantly demented, going off constantly, sometimes as much as two-hundred times in a day without rhyme or reason in what Smith refers to as “pager incontinence.” This is a distant cry from its infancy in medical school when it maybe buzzed once or twice a month. “We were best friends in medical school; it was so exciting to get a page then.”
Palliative Care was consulted and helped facilitate the discussion between Smith and his pager. Also in attendance was a chaplain, hospital operator, and information technology. It was hard on everyone as they watched the helpless pager convulse like a seizing metallic parrot. It kept chirping that it needed a new AA battery. But no one had a battery. It became so unbearable that nursing came in to restrain it with an upside-down coffee cup.
Smith’s pager showed the wear and tear of daily use and being thrown against the ground and set on fire repeatedly over the years in sheer anger and frustration. Smith had used it as a baseball in the batting cage and even used it as target practice on the gun range. (“Pull!” Smith recalls vividly.) It had been a constant and painful reminder of its anachronistic existence in a healthcare system that is modernizing and crumbling at the seams.
In other words, it’s a piece of sh*t.
“It needed to be a DNR, it needed to be turned off to rest in peace and never ever be turned on again, for its own sanity and mine,” Smith said in peace with the decision. “We thought about inpatient hospice but I thought it best to take a shovel, pummel it one last time, and bury it in the ground.” Smith doesn’t plan on holding a memorial. He wants to be alone with his pager, so he can salute it properly: two middle fingers and a crotch crab.
“It’s been real,” Smith emotes. “Real effing terrible.”