It’s December and we seem to get more than our quota of GI bleeds around this time of year. I guess it’s because the colors are so festive… Bright red and dark green.
A vague abdominal pain in a 27yo female on who is beginning her menses is not an emergency. She may think it is, but it is not.
Unfortunately, there is just no reasoning with crazy people. It’s “if you can’t see me in the next few minutes, I’m calling ______! (Fill in the blank with any political official from the current hospital administrator up to Barack Obama).
So, In the years I’ve been an ER nurse, I’ve had my share of people complaining to management about me.
Once a woman complained to my manager that I was racist, because I triaged three pretty sick patients ahead of her mildly sick 6-year-old son with a runny nose and sore throat. There was a 78yo with crushing chest pain; a 32 yr with a GSW to the back at diaphragm level with sats at 66%; and a 62yo man with new onset altered mental status and severe weakness on the left side. The funny thing was that all of them were the same race.
Then there was the “dance instructor” with fibromyalgia who also had a “past history” of IVDA. She wrote a detailed complaint letter because I wouldn’t let her go home with her hep-lock in place so that she could “self-dose.”
All of these I can understand, to a point. People are feeling sick and worried. They’re not at their best, and are unable to see past their own personal needs at that moment. But the latest one took the cake… for now. I’m sure something else will eventually come along to top this. It always does in this profession.
I frequently question the trustworthiness of hospital management. However, I still maintain a vague sense of naive optimism when it comes to, what I call, “doing the right thing.” As long I know in my heart, I’m doing what’s right for the people involved, somehow I will be protected from ridicule and especially, liability. Of course, this is complete and utter fantasy-land. Everyone knows that management will throw anyone, even one of their own, to the dogs to save just one dollar, or especially to save a potential liability. Doctors are just a tiny click above hospital management when it comes to trustworthiness.
I’ve had my run-ins with doctors. Unfortunately, new nurses tend to get into the worst trouble early in their career simply because of their blind trust for both of these groups. Everyone just thinks that the doctors are there for the patient. They even have a doctor club chant of “do no harm”. This seems to occasionally go on hold when it goes against their income potential. Now, I know I’m sounding a bit cynical, but don’t get me wrong, some doctors are really good and earnestly want to do the right thing for the patient. Unfortunately, most want to make a buck. Most patients don’t realize that they make their money by “doing stuff” to the patient. It’s like the used car salesman trying to sell the undercoating or the extended warranty. I learned this right off working at a radiation therapy clinic. We dosed people with heavy, DNA altering radiation and billed them a large amount for a tumor on their neck when everyone knew that they already had metastatic cancer to the lung, liver and pancreas. They were dying and we were milking that last dollar for everything it was worth. Our treatment was quite expensive and did nothing toward their benefit except maybe giving a tiny bit of false hope. Some counseling and hospice care would have been far more kind to these people.
When the Air Hits Your Brain: Tales of Neurosurgery
This writer is a bit more cynical than I am, however it is strangely true. He somewhat unfairly groups all doctors into two groups. A: The one who does procedures only to make money and B: the one who does the right thing for the good of the patient. Doctor B will talk with the family and recommend what is needed. He is not that popular nor does he make a huge amount of wealth. Doctor A competes with himself as to how fast he can do any given procedure. He can have a pediatric patient die on the operating room table at three and still make his five O’clock T-time. In real life, I work with both doctors almost daily.
New, altruistic nurses need to take warning, when there is an argument, the hospital administration will side with the doctor. Especially with Doctor “A”. Regardless of ethics, the doctors bring in the money, and the administration really loves that revenue. So as much as it may darken your soul, you need to really pick your battles.
I got into an argument with a resident recently because they wanted to put in a chest tube. I said “hey, take a step back and really do an assessment. Do not get mad at me because I won’t witness your consent. The person you want to stab with a chest tube is not some big healthy 20-year-old kid. It’s a frail 70-year-old lady. Although she looks pretty healthy, even with a pneumothorax. But she doesn’t speak a word of English and even I can understand that she’s scared about what you’re wanting to do. Please don’t be mad if I grab one of our attendings who happens to speak the same language… (as the object of your chest-tube lust).
“Come on, let’s get it done… this old gal is tougher than you give her credit for” he says. “You do know you can’t get informed consent using hand gestures not even if your patient is nodding and smiling politely.” How about let’s get a consult with your attending, Please, I insist. Really do an assessment this lady, she’s stable, her O2 sat is 99% and is not complaining of SOB. She can certainly wait until your attending gets here.” The resident insists and I use my last card, “I’m not signing or witnessing anything.” I say in my sternest voice. He storms off.
I feel that the bedside nurse is the one and only patient advocate in the health care system. The patients are depending on us to stay current in our practice, be up to date and give the best advice. It’s a huge job, but I feel that I have to do my best for my patient. It’s the only way I can sleep at night.
The shift eventually comes to an uneventful end. No deaths, no lawyers, no serious complaints. I give report and head out the door.
Management calls and leaves a message on my machine begging me to come in “for any part of tonight…any part…a few hours, that’s all…please…I’ll make any deal you want… All your weekends off next month? Anything! Call me please… beep”
I’d consider it, but I just worked five 12-hour shifts in a row. I’m beat, and I’m already in my comfy clothes on the couch with a beer a pizza on the coffee table and Robot Chicken on the DVD. I’m not getting up.