This was a momentous week for me. After 14 years of carrying a hospital-grade old-school text pager to receive messages at work (yeah, that’s still a thing with doctors), I finally traded it in for a cell phone app. It should have been easy to get rid of my beeper, but instead I felt waves of nostalgia when I turned it off for the last time. Those 240 character pre-Twitter, low-resolution LCD messages follow the arc of my medical career and tell its story.

It starts with a sound, and trust me when I say those innocent little boxes rival the volume of say, car horns or maybe ambulance sirens. As a resident I never put my pager on silent mode for fear of missing something crucial, like a patient becoming critically ill under my watch. Not surprisingly, the so-called pleasing alert I chose for my four years of training- an endless arpeggio of mechanically flattened G-B flat-E flat-G that moved neither up or down the scale- still gives me panic attacks.

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That arpeggio could strike any time, each page spinning a deeper and deeper web of multitasking until I was stuck in a cocoon of tasks hopeful for the hour I would emerge as something better. I knew I had arrived when as a fully grown attending physician I changed the tone to a silent vibration. It signified a shift in my role, the ability to focus more on talking to a patient or a colleague, to keep my work pure and my interruptions in the background.

So what happened when the beeper beeped? Consider this 4am page from a nurse:

Jennifer 41234 What is the plan for 32a? Please call.

Night residents have the Sisyphean task of keeping up with a constant assault of pages. As a resident focused on self-preservation and survival to me this message meant “What did I do to deserve this page? Why does she need to know what the plan is at 4am? The day team will be here in two hours and they can figure it out.” In between beeps there just wasn’t the time or space for me to realize that 32a was really Mrs. Jones, who was not used to being awake and alone in the dark.  Her frail bones were tangled in a thin blue gown and her bloated feet writhing against twisted terry hospital socks matched the rhythm of her churning mind: “What’s happening to me. What’s happened to me.”

Sometimes, though, the meaning behind the characters knocked me off my feet and slammed me down a rocky ravine even as I clung to the next thing I had to do on top of the ledge. As a second year resident I remember the message that simply said “mom” and a phone number. When I called back during the middle of a long workday, my usually stoic mother was on the verge of tears. “They asked me if I wanted to bring him back,” she said of my ailing, hospitalized father, “and I said yes.” I ran around at work for several more hours until I was able to tell someone that I had to leave. Then, not long after I became an attending I walked in the hospital lobby a doctor, but after a puzzling page from my own physician and the conversation that followed, walked right out that same door as a patient, a cancer patient.

And this ominous message has been saved on my pager for a year and a half:

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It’s how I found out that my colleague, friend, and mentor unexpectedly died. There he is saved on my pager, in all-caps, watching over and laughing with all of us.

It wasn’t all bad, though. Even as attendings we sent joke pages to each other, carefully, knowing that some big brother somewhere was monitoring all of our words, that everything was logged in The System, which was kind of like that mysterious Permanent Record that followed you through public high school. We vented by pager, and sent rescue pages to our friends when we thought they couldn’t otherwise escape a bad situation. Pulling that smoking beeper from its holster and seeing a message that made me smile, well those were the words that got me through the day. As an intern I saved particularly motivational messages from my senior residents such as, “You can do anything for 24 hours!” That phrase stuck with me through my hardest moments well beyond residency: sleepless nights with twin infants, for example, or twelve mile training runs.

Let us not forget that pagers were indestructible, surviving falls down flights of stairs, and even into the toilet- not mine, I never did that, thankfully, but I know people who know people who did. Speaking of toilets, our beepers proudly beeped in the darkest bowels of the hospital, my own office being one of these places, unlike my cell phone which lamely proclaims “No Service” as it sits on my desk. And also unlike phones, with a pager, no pockets? No problem. That little thing could be attached anywhere. Now this was a revelation: I could preserve my sense of style and be a doctor too, strutting around with my retro-cool beeper clipped to my new-attending-splurge boots. What I’m trying to say is that no matter how hard you tried you could never make your pager go away, you had no excuse for not having it on your person, and you certainly couldn’t make it die.

These days, social media is all about using the briefest phrases to create the most elaborate stories. But my archaic pager, it turns out, was years ahead of the game. Those pixelated gray characters on a bilious green background spoke of Tylenol orders and chest pain, life and death, humor and support. So my pager, farewell to thee. I don’t know if I will miss you, but I’ll always cherish the 240 character snippets you’ve left with me.

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