Tuesday, May 19, 2009

Eejit doctor

There is a mindset among some people, particularly older members of society, that doctors are demigods.

Their word is law, their instructions divine. They are not to be doubted or crossed, no matter how assinine or impractical their advice is.

I am not one of those people. I have seen enough physicians at work to understand that they are human and that some are better than others...and some are, to be blunt, farkin eejits. Usually the eejits are weeded out during residency and aren't practicing in my particular field, but some slip through the cracks and could even be working in an ER near you (Dr Bloody Gloves, I'm thinking of you in particular here).

It was my great misfortune to see one of those eejits in action.

I was working Inner City Ghetto ER. We had just had an almost-pulseless and apneic 2 year old with a complete airway obstruction choppered out to Big City Pediatric Hospital (removed the chunk of food he was choking on and resussitated him successfully, thankyouverymuch). We had cleaned up the trauma room and were standing at the nurses station dissecting the events when I hear a "SOMEBODY SAVE MY BAYBEEEE!" and turn to see a very large man carrying a toddle who was clearly in status epilepticus. He shoved her off into my arms, and I turned and headed into the trauma room with her as fast as my little feet would let me.

She was 18 months old, he said. No previous medical problems, he said. Not medicated for anything, he said. Not allergic to anything. My heart in my shoes and 'not again' running through my head, I laid her down on the gurney and started taking her clothes off. The nurses were around me in an instant, telling me to take her clothes off and help start an IV.

The doctor in the ER that night was not educated in the US or the UK.... and he was not known for his bedside manner. He had made it known that he was not comfortable working on kids....yet here we were, working on the second pediatric near-code in a row. It just wasn't his night, I guess.

He came in the room, rolling his eyes, and ordered RSI drugs....in amounts appropriate for a 6 month old. One of the nurses asked if he wanted Versed first instead, and he said no. Another nurse had broken out an ET tube and the accompanying Broslow tape and mentioned that the appropriate dosing for a child her size was quite a bit higher than what he had ordered. The doc just grunted and said that he didn't go to medical school to be told by some piece of paper how much to give and repeated the dosages he wanted to be given. All this time, the child is still seizing.

He assembled the laryngoscope, looked me in the eye and told me to hold her head whilst he intubated. The nurse pushed the RSI drugs in,but instead of the patient becoming still she carried right on seizing. I glanced up at the charge nurse as if to say 'is this guy fucking serious???' and she just nodded at me and shrugged her shoulders. So, I tilted her head and did my best to hold it still whilst the doc shoved the 'scope down her throat.

Once he was in, he asked me to check for breath sounds. I listened and heard them on the right - but they were absent on the left, and reported those findings to the doc.

"It's in right, you just don't know how to listen" he said.

"no, really, I'm no.....owwwww!!" I began, but shut up quickly when the nurse next to me delivered a swift kick to my shin.

"Umm...she's still seizing. DO you want to give Versed? Ativan? Valium?" the charge nurse timidly piped up.

"Who's the doctor here?" he snapped. "You think I need you to tell me my job??"

There was silence in the room.

"Give her some Versed..." and he walked out.

"How much?" asked the nurse.

"I don't know, however much you think. Perhaps you can consult your Oracle tape..." and he waved his hand dismissively before sitting down at the nurse's station.

The nurse rolled her eyes, drew up the meds and pushed them into one of the two IV's we had running. The seizing didn't stop, but it did slow significantly. However, her O2 sats were at 89% and dropping and her pulse rate was slowing. The nurse reported this to the doc, who ordered Atropine.

Once the Atropine was in, her pulse rate came up - to over 200 bpm's. Her sats were still in the low 90's, but she was now tachycardic - and dangerously so. The nurse yelled out to the doc that she was tachy, and he grunted back that the monitors were wrong. I was at her head, bagging, so I placed 2 fingers or her carotid and counted her pulse rate manually. The doc asked for a pulse rate again, and the nurse told him what it was - over 200.

When he heard, he got pissed. He stood up, face red and creased with anger, and told the nurses he didn't know what they were talking about and that they were all fucking wrong and too fucking stupid to know what they were doing, that it couldn't be over 200 with the O2 sats she had.

There was silence in the room, save for the beeping of the cardiac monitor and the hiss as I squeezed the Ambu-bag. Every nurse looked down at their shoes, silent.....

...but I wasn't quiet. I had had enough. Enough of seeing this child seize, enough of seeing her sats drop because he wouldn't let anyone retract her tube, enough of his 'I am the DOCTOR, don't you DARE question me" attitude...just enough. Of him. Of everything that was going on this this kid.

"it's NOT wrong; I have my hand on her carotid and it IS that high. You gave her Atropine, remember??!!!"

To use the cliche, if looks could've killed I'd have been dead before I hit the floor. His face turned purple, he gritted his teeth, and I heard a murmered "oh shit....I hope you don't like your license much'' from someone in the room.

"Oh really, Miss Know-It-All? Well, how about you run the fucking show seeing as you know so much? I'm done here".....and he walked away down the hallway.


To be continued....

3 comments:

Anonymous said...

And i bloody hope you did!!

Ninjamedic said...

Anon: You hope that I did what? Run the show, or lose my license? :-)

Medic(three) said...

good going girl!

Too many people pull this shit!

BTW... medicthree.com is back live, and courtesyshock.com has been tabled.

Keep up the good work!