Thursday, October 25, 2007

Just another call day, or good nurse, bad nurse II

Me imperturbe, standing at ease in nature,
Master of all or mistress of all, aplomb in the midst of irrational things

Eleven am. I walk into the hospital, change into scrubs, and within ten minutes I'm admitting my first patient of the day. By mid afternoon, I'm collecting signouts from the other teams, and by 6pm I am responsible for the medical care of some fifty patients overnight.

At about 9 pm Mrs. Stone really lost it. She was frustrated with the primary team's treatment of her husband, and utterly convinced that IV antibiotics were better than oral. So she and her husband decided that was a great time to page me, the night call resident, and demand IV antibiotics. I remained as calm as possible while explaining to her that the particular fluoroquinolone her husband was on had exactly the same bioavailability in either IV or oral form, and that a UTI was not, in this instance, life threatening, but she was having none of it. Her concern I could understand. Her manner I could not, and as her voice reached a level which was probably audible from several adjacent floors in the hospital, as she denounced my ability to have compassion, my intelligence, my understanding of medicine, and virtually every person connected with her husband's hospitalization, the charge nurse (blessings on her and her children) came in and interrupted by saying that visiting hours were over, and that if Mrs. Stone did not remember the way to the exit, the security guards would be more than happy to show her the way out.

Three am, and I am awakened from my one hour of sleep by a nurse who feels that this is a great time to pass on to the night float doctor the results of several perfectly normal, non-emergent tests performed over the course of the day. The sorts of test which will not, by any stretch of the imagination, change the management of the patient in the next three hours before the primary team comes back in.

Eleven am. I am now in the step-down unit, dealing with my patient who has developed mental status changes. I am very suspicious that these changes are due to the fact that he has bad COPD and has been off his oxygen. I need an ABG, quickly, to determine whether the oxygen I'm about to start is going to fix the problem, or whether I need to keep looking for a cause. The patient's nurse has decided that it is far more important to gossip about another doctor to one of the other nurses than to actually draw a lab that might help her patient. I try telling her nicely, but she will not be interrupted. So, exasperated, I draw the lab myself and make a note to write up an incident report.

Four pm. The bed manager finds out, and pages me about, the fact that one of my patients has been off telemetry monitoring for most of the day, because the nurses can't find the tele pack. They've only now decided this is worth passing on. Another twenty minutes of work. That will teach me to think of getting out of the hospital early post call.

Five pm, sign out complete, my patients passed off, my pager off, I drive home. And in just under twelve hours, I'll be right here, headed the other direction, starting all over again.


Alice said...

Love your opening lines. Walt Whitman? Which poem?

I completely sympathize with you on the difficulty of getting labs drawn and then processed. I've taken to calling the lab on every stat test I care about: "Hi, just calling to see if you got my patient's blood sample; and does your computer show all three tests I ordered?" I wonder if you'll ever hear back about that incident report? There's probably a black hole somewhere for such things.

Nathan said...

Yes, Whitman, I'm impressed. I think it's from Song of Myself, though I'd have to check again to make sure.

And personally, I'm certain there's someone in the bowels of the hospital whose sole job it is to shred incident reports without reading them.