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24 Hours On Call

TUE 5:03AM Just over two hours later, the code-blue pager has summoned Ryder and her team to the Cardiac Care Unit. After reviving the patient, the team didn't leave right away, since "we thought the patient was going to recode—which he did," says Ryder. They revived him again.

TUE 6:27AM Even the busiest health-care providers stop to enjoy a little socializing now and then. Here, night nurse Candace Colby- Collier is admiring Ryder's wedding photographs (she was married on June 25, the same day she finished her internship year), while Ryder writes up more patient orders.

TUE 6:46AM Laquer, D'Souza, and Ryder are conferring at the work table behind a nursing station when a nurse delivers some distressing news about one of their patients—he had become agitated and ripped the intravenous tubes out of his arm before anyone was able to stop him. Ryder heads right down to the patient's room and decides how to handle the situation. The team has already begun making rounds on their other patients. On most days, the intern pre-rounds by herself, before regular rounds, so that she can update the rest of the team on the patients' status. But on post-call days and on weekends, the team instead does "discovery rounds," visiting the patients together. "We try to gather data as efficiently as possible as a team," explains Ryder. She chats with each patient and checks their vital signs while D'Souza writes the progress notes. "We'd talk about the plan as she was typing it up. So then we'd all walk away with a plan in place."

TUE 7:46AM It's time for morning report again. Ryder nibbles on a scone and sips a cup of tea as she listens to the presentation and discussion. She also hands over the code-blue pager to the resident whose turn it is to be on call for the next 24 hours. After morning report ends, Ryder continues checking on her patients to be sure that she passes along any pertinent information to today's on-call team. She finally heads for home, after 30 hours in the hospital, around 1:00 p.m.

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Photojournalist P.J. Saine's work has appeared many times in these pages—most recently in the Spring 2005 "Art of Medicine" section; he has been the manager of ophthalmic photography at DHMC since 1997. Laura Carter, the magazine's associate editor, accompanied Saine for 12 of the 24 hours represented here. In the photo captions, the times are exactly as recorded by Saine's digital camera and identifications are from left to right. Italicized quotations are things said at the time the photo was shot; other quotations were explanations Ryder made afterward. Pictures of patients were shot only with permission; identifying details about other patients have been changed.

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