March 29, 2026

Pager PTSD: A Physician is Triggered by the Beep, Twenty Years Later

This past week I was in an airport, returning from a fantastic family vacation. I was as relaxed as one can be whilst sitting and awaiting one’s boarding call. Then, from somewhere nearby, there was a beeping noise — a coffee shop’s electronic coffee maker, perhaps.

It wasn’t a loud beep, but to me, it may have well have been bomb sirens suddenly piercing the air. I jumped, startled, and whirled around in a panic. A barista behind the counter nearby flipped some switch, the beeping stopped, and I came to my senses.

Why the reaction to a little beep? Realistically it shouldn’t have been considered obtrusive in any way, except for one critical factor: it sounded similar to the little beep of my hospital practice on-call pager.

And that shouldn’t matter either, because it is now 2026 and I haven’t worn that pager for over 5 years, seeing as I left clinical medicine in 2021. And even then, our internal medicine practice had transitioned the in-hospital coverage to the Hospitalist team long before, so being paged no longer meant shlocking into Boston to admit a sick patient up on the wards or direct their care for the resident team, all of which carried significant professional responsibility and intellectual burden. For my last years in practice, being paged meant we only had to answer calls from our patients, solve their medical problem, and then document the interaction in the electronic medical record. One could do that from the comfort of one’s own home, while wearing pajamas.

So, why on earth did I jump out of my skin for this benign coffee maker alert, when it’s been so long since I’ve carried a pager, and even then the pager signified nothing more than returning phone calls?

Well, Pavlovian conditioning plus psychological trauma runs deep tracks in the neurological pathways of the brain, and my pager training had begun far before and involved far more. I went through medical training well over 20 years ago, but apparently, the neuro-emotional effects last for life.

As a resident on call, we were in the hospital, often covering more than one service. As an example, when I was on General Pediatrics call at the large academic medical center, we would cover two floors: toddler and school age. Back then, each floor had their own pager. Then there was the clinic pager. This in addition to my own personal pager. So it was not abnormal to be wearing 4 pagers. I had to double-knot my scrub bottoms so they stayed up with all these pagers clipped to my waist. It was a feat to use the bathroom and not lose one down the toilet!

And they beeped. A lot. I remember being on call one overnight at a small satellite hospital. I was the resident covering the Peds inpatient ward, ICU, admissions, and backup for labor and delivery. I was paired with an intern who was thankfully a smart and cool-headed guy. For most of the night, we were taking care of a newly admitted teenager in diabetic ketoacidosis. The teen was on an insulin drip, and their blood sugars, electrolytes and acid/base balance had to be watched carefully. We were being paged so often about the teen that we decided to just stay up in the Peds ICU with her.

But, BEEP! A code in the ER! An 8 year old in status epilepticus. We ran and got there at the same time as the on-call anesthesiologist. We decided to sedate and intubate the boy, give as much Valium and other antiepileptics as we could and call for transport to the Main hospital.

Then, BEEP! we were STAT paged to a delivery. The resident covering Neonatal was already in a delivery, and there was another imminent delivery that required Peds presence: premature twins. They were 32 weeks gestation, which is little but not too too little. They would need to be in the NICU (Neonatal intensive care) for a few weeks, but they were fine.

We ran from emergency to emergency and in between we had numerous other pages: issues with the admitted children on the ward, BEEP; some new admissions to go and see, BEEP. We split up to try to cover it all.

That was a pretty bad night on pediatrics, but it wasn’t abnormal. Internal medicine nights could be worse, because admitted adults tend to be old people with bad hearts and all, so codes were much more common, and people died more often. The medicine code pager, which went off if there was an adult in cardiac or respiratory arrest somewhere in the hospital, had the most obnoxious singsong sound: REE-OO-REE-OO-REEEE. Well I remember being paged to a code in a community hospital’s small dialysis unit, and an unconscious gentleman with a hyperkalemia-induced cardiac arrhythmia (high potassium level messing up the electrical conduction of the heart). No sooner did we get there, when the patient in the gurney next to him went into full cardiac arrest, possibly from the shock induced by his neighbor’s medical emergency. The stupid code pagers all went off again: REE-OO-REE-OO-REEEE…, even though the team was all right there, already doing the whole intubation and CPR thing. Just thinking about the code pager brings back memories of multiple medical nightmares past. For years, if someone’s pager was set to that tone, I went into a special panic, and then I wanted to yell at them to change the goddamned tone. (Curious about the code pager tone? It’s the third one, 18 seconds in on this YouTube video.)

After training, when I was finally an attending at a clinic, I purposefully set my pager to a sound that wasn’t at all like the ones I had in residency. It was a little “Bip!”, almost a chirp, really. But when that thing went off, I might as well have been back on the floors again. I was like a soldier just returned from ‘Nam, man. Just a tad PTSD.

Early on in my attending hood, there was a Fourth of July weekend where my office was closed on the Friday the 3rd. I was on call starting that morning. It was a beautiful day, sunny and warm. But the pager went off every five minutes for the whole day. I was at the hospital, fielding calls, reading charts, looking up answers, trying to keep track of all the issues. The calls piled up. People were annoyed that the office was closed, because they hadn’t expected that– it was the 3rd, not the 4th, dammit! Then they were annoyed that I took so long to get back to them. I went into a full-fledged panic attack at one point, hyperventilating to the point of almost fainting. I got out of it by forcing myself to breathe slowly and deeply, because I didn’t want to end up in my own emergency room.

I remember being on call when my kids were little. We would take call for a week at a time, rounding on inpatients in the daytime and answering any calls overnight. Here’s an example of a typical nighttime:

I put the babies to sleep, set my pager on the bedside table, turned out the light, and nestled down for the night, or, at least as long as my kids would let me sleep. Then, “Bip!” the pager went off. I startled and turned the lights back on and fussed with my glasses and looked at the page text: an urgent page from someone with a sore throat. Sigh. I got up, logged into the computer, pulled up the patient’s chart and called her. A young new mom, her baby is in daycare and is on his 3^rd course of antibiotics for an ear infection. Now she’s had a very sore throat and fever over 101 and difficulty swallowing. She knows she should have come into the office, but between work and the baby, she couldn’t. She’s miserable, she’s pretty sure this is Strep, can I help her? Sure. We chatted, she was very gracious, and I felt good to be able to help her out. I called in her Amoxicillin and that was that.

I again set the pager down on the bedside table, turned out the light, and settled down to try to sleep. But how could I sleep when I kept worrying and fretting that the pager would go off again? I started drifting off to sleep, and hallucinated that the pager beeped. I woke up and turned the lights on and stared, but there was no blinking callback number, no message.

I finally dozed off. Then, at 4:30 a.m., “Bip!” From the deepest sleep, I startled, turned the light on, fumbled with my glasses, and looked at the message. An urgent call for nausea, vomiting. I sighed, pulled myself up and to the computer, and dialed. The lady had school-aged children. She couldn’t keep anything down. I talked to her husband. We agreed that he would take her into the emergency room. I called the emergency room to let them know she was on her way and that I suspected Norovirus, that she would likely need IV fluids. I typed a brief note. I went back to bed. But two hours later, I was still awake. That’s when the babies would wake up so, no catching up on sleep for me.

Now, as a physician in biotech who manages oncology clinical trials, I do not carry a pager. But technically, I still take call, in the sense that if there is some medical issue with a patient on a clinical trial I am overseeing, the oncologist absolutely can call me to discuss. This happens rarely, but it does happen, and because our clinical trials are held all over the globe this means I have to be prepared to take a medical call pretty much anytime.

So, no pager, and I swear I will never again wear a pager. I will, apparently, always have pager PTSD, seeing as the pagers I’m talking about are now considered “vintage 90’s tech” (that is what I found the image and audio under!) and my kids, born well after I completed training, are now teenagers in high school.