Wednesday, May 20, 2009

Part II

The nurse standing next to me murmured 'dang, girl! you like yo job much? But you know whut? I'm glad you said it. Needed to be said. That mofo cusses at us all the dang time and I'm sick of it...'

"What the hell is going on in here?!" The PA from fast track had heard the doc shouting and cussing and had come to investigate.

"NM told the doc off and he left" said the charge nurse.

*remember that the patient is still undermedicated and in the brief moments between seizure activity she's trying to fight the ET tube*

"You what? What the fuck are you thinking?!"

"I didn't tell him off, exactly" I retorted "He was cussing at the nurses about this kid being tachy and telling them they were fucking stupid and couldn't take a pulse right, but he'd given her Atropine....I just reminded him of that and told him I had my hand on her carotid and that the pulse rate IS that high."

"...and he left you in the lurch here?"

"Uh huh. He also refused to retract her tube even though I told him I couldn't hear breath sounds on the left. I think it's in her right would explain the O2 sats. But hey, I'm just an EMT....what do I know?!"

"Gimme your 'scope" the PA said. "I'll listen"

He listened to her left chest for a few seconds, ripped the scope out of his ears and said "retract that damn tube a coupla inches; it's in too far. Why is she still seizing? How much Versed has she had? What kind of clusterfuck code is this, anyway? far out is that chopper?"

Right on cue we heard the distinctive whub-whub of the medevac helicopter from Big City Pediatric Hospital. A couple of moments later the crew walked in with their gurney and bags. They got report from the charge nurse, checked over their patient, MEDICATED HER ADEQUATELY, and off they went. The nurses, PA and I were left in a room littered with the detritus of a code....gauze pads, tegaderm backings, empty packages from the sterile equipment. I stripped off my gloves and wondered aloud what I was supposed to do now.

"I guess I'll start clean.."

"Was that the chopper I heard?" The doc appeared in the doorway. Everyone looked at their shoes, me included.

"Yeah," said the PA. "She's gone off with them.....and that ET tube WAS in too far. I had to retract it."

"Oh.....NM, I need you to come with me. Now, please."

My heart was in my shoes again as I followed him down the hallway to the doctor's lounge, and when he asked me to close the door behind me I made a mental note of thelocation of the nearest trashcan. Nausea was already washing over me and I was sure I'd hurl at some point.

He rubbed his face with his hands and sighed. "I hate working on kids, y'know. I mean I HATE it. There's always this added drama and.....well, I detest it. You know, I could have you fired for what you said to me..."

I had gone in there with the intention of being contrite and apologetic, but what I perceived to be a somewhat veiled threat caused a fire of fury in my belly.

"Excuse me? For reminding you that you gave a medication that can induce tachycardia and for sticking up for the nurses?"

"You questioned my authority!"

"No, I reminded you of something I thought you could have forgotten, and I did so because I was concerned for my patient. I was as polite as possible; I didn't cuss - unlike you, who dropped the 'F' bomb gawd knows how many times and told the skilled nurses they're stupid and dumb! You know, I came in here thinking I was going to apologize and be all demure and repentent, but you know what? I changed my mind. I'm not sorry for what I said, not at all. I had the welfare of OUR patient in mind, and I didn't do anything if you're gonna fire me or get me fired, just fucking do it, dude. I know I did the right thing and I'll be able to sleep at night. Don't threaten me, just do it."

"Are you done, little Miss KNOW-IT-ALL-EMT?" he raised his voice and scowled......and then he smiled.

"I'm not going to fire you or have you fired. I'm not even going to write you up. I can't fault you for caring about your patient.....if I'm honest with myself I can't even fault you for saying what you said. I didn't - I DON'T - like it, but I can't condem you for it. Don't think for a second that I'm condoning it, though, because I'm not. You got lucky this get back out there and clean that shit up, and act like I scolded you good whilst you're doing it. I have a reputation as a crotchety old bastard in this ER and I'm not about to let you fuck that up, too."

"Whatever. I suppose you expect me to thank you?"

"No, I expect you to go do your job. I like that you're not afraid of me, NM, but don't let that attitude get out of hand. It'll get you into bigger trouble than you can handle one of these days. Now GO!"

When I got back to the trauma room the mess was all but cleaned up. I grabbed a pair of gloves and the disinfectant spray and started spraying down the stretcher.

" you still have a job? A license??" The charge nurse asked.

"Barely" I said. "I really don't want to talk about it. That guy....."

" an ass" someone else said. "A prime grade A ass. Nobody likes him...I told my husband that if I ever got seriously hurt or was really ill he's to take me somewheres else if that ass is working here. I wouldn't trust him to work on my worst enemy. Girl, we're about done here. Go on and get yourself a soda and take a break for a bit. You deserve it....and thanks for making a stand like that. Nobody else is gonna say it, but I will."

I don't make a habit out of back talking and second guessing physicians. I realize that my medical education is rudimentary at best when compared to theirs and I respect what they've done to get to where they are. However, just like every other profession, there are a few doctors who make me wonder if they went through medical school and internship by proxy; if they didn't pay someone else to do the work for them because their medical knowledge is so horribly bad. Those are the docs that I struggle to keep my mouth shut around. Luckily I don't encounter them too often.

As for our patient that night....they spent almost a week in the hospital under the neurologist's care. It took a little tweaking to get their epilepsy under control, but with the help of a couple of medications they made a full recovery. Thank gawd for that.


Raindog said...

Great Story.

Walt Trachim said...

You did the right thing. I would've done the same myself. In fact, I did once and it came close to getting me fired. But I didn't care, and the doc I was dealing with knew that. And, I would do it again if it keeps the patient safe and alive...

A great post.