Insomnia snark

It was about 2:30 am when the phone rang, waking me from the deepest and best part of sleep. It was the answering service, and they patched my patient through.  

Me: (Still groggy, trying to wake up.) “Dr Elias here, on call for Family Health. What’s the problem and how can I help?”

Female voice: “I can’t sleep.”


Me: “Hmmm. I see. Can’t sleep?” (I was taught to use reflection and open ended questions to avoid directing my patients to the answer I prefer, a technique I find invaluable. This time, however, I was just stalling while I forced myself to wake up.)

FV: “Yeah. Every night I go to bed at 10:00 and fall asleep fine. Then I wake up at 2:00 and can’t get back to sleep.  It’s been going on for three weeks, almost every night. What can I do?”

Me: (Now awake. Irritation trumps fatigue.) “What have you tried?”

FV: “Warm milk and a hot shower. I’d try sex but my husband works nights.”

After a brief conversation during which I established that she was’t having trouble breathing, chest pain, bleeding, neurologic symptoms and wasn’t in an unsafe setting, I explained that there was nothing I could do about this problem on the phone in the middle of the night, but that if she made an appointment to see me in the office, we could pursue what might be causing it and what her options would be.

FV: “Thanks. Good bye.” Click. I went back to sleep almost instantly - though my wife told me in the morning she lay there for hours, baffled by what she had heard. She did not call for an appointment and I forget entirely about it.

Fast forward about 3 months. It’s about 2:00 am and I’m leaving the Emergency Room, having just admitted a patient with pancreatitis. As I drive home, I think to myself how tired I am, how much sleep I need, and how I hope no one calls me with some trivial complaint like insomnia. The memory of that insomnia call hits just as I reach the intersection where my office sits, and I cannot resist. Physicians are (most of the time) professionals and supposed to be able to rise above the need to snark, but I was too tired and the urge was too strong. I pulled into the office parking lot, unlocked the door, looked up the insomniac’s chart, and dialed. A voice whispered to me that I was being immature and unprofessional, but I ignored it.

A sleepy female voice answered the phone: “Unhh. Hello? What? Who is it?”

Me: (Cheerily.) “Good morning. Dr. Elias from Family Health here. I’m not sure you’ll remember, but you called several months back about a sleeping problem and on the way home form the hospital just now I realized I had never heard back from you. I’m just calling to see if your sleeping issue is resolved or if you are still having trouble?”

FV: (Fully awake and clearly irritated.) “It’s 2:30 in the morning? Why are you calling me at this ridiculous hour?”

Me: (Quietly and struggling to suppress my embarrassment.)  “I was just following your lead. You called about your sleeping issues at 2:30 so I assumed that this was a good phone time for you. Sorry if I woke you up.”

(long pause)

FV: (Soft voice.) “Oh….No, I’ve been sleeping fine lately. It’s been fine ever since my sister’s husband got his biopsy report saying he didn’t have cancer. Sorry. I think. This is awkward. Good night.” Click.

The rest of the way home I berated myself and debated whether I should call and apologize (during the day) or send a note. I did neither, but months later she was in for an unrelated problem and I took the opportunity to say that I was sorry and regretted my childishness. She waved my apology off and said that initially she hadn’t known whether to laugh or be angry but had decided over coffee with her husband the next day that she had deserved it. 


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