Jerk-face

WARNING: this may be long and detailed

I learned a very important lesson in the hospital today. Granted, I knew the lesson in theory already, but today I saw it in practice. Doctors can be amazing or they can be utter jerks. I spent my day in the Critical Cardiovascular Unit. Most of the patients have just had major heart surgery or are very hemodynamically unstable. One of our patients (of two) had multiple issues going on and without being too specific, he was one day status/post major chest surgery. He had two chest tubes draining excess fluid from the sac that holds the lungs and a very large central line in his internal jugular vein. He was pretty stable, but also had Alzheimers. He was confused and just wanted to get his clothes and go home. He had been ok until his night nurse had started to mess with his foley catheter (which goes to the bladder). It is very hard to maintain a man's modesty when dealing with foleys which is unfortunate as most nurses are women. I can understand the embarassment, awkwardness, and frustration that guys must go through...but to be confused on top of it; I'd be combative too!

When we came on shift we were careful to maintain his modesty; and he made sure we knew that we were NOT to interfere with him. He was already sitting up in a chair, complete with all his tubes. We entered his room for his morning assessment and noticed his heart rate was in the 150s, when normal for him was 90-110. Not good. His blood pressure was ok, so we immediately thought pain - a logical conclusion given the circumstances. He indicated he was indeed in pain in his side, near his surgical site. We assessed the site and made sure his chest tube was draining appropriately. No problems there. He had a standing order for morphine, which we then administered via IV push.

Fifteen minutes later we came back to reassess his pain and vital signs. Uh-oh...his heart rate was still in the 150s but his BP was in the 70s/40s. Yikes! We checked his BP again and his systolic was in the 60s. The doc was supposed to be in the OR with an open heart procedure, but we paged him anyways. What a shock (sarcastic), he wasn't even at the hospital. I should have known that was a bad sign. He told us to start infusing him with tons of fluid as it seemed like he was hypovolemic (low fluid in the vascular system) and start him on Amiodorone and Digoxin, both drugs which increase blood pressure and contractility of the heart. The patient immediately improved and was ultimately fine. Side note: we had already prepped the meds before the doc called us as we knew that this is probably what would be ordered.

When the doc showed up 15 minutes later, he proceeded to chew the nurse out because the morphine had caused the drop in blood pressure and she should know that. He never even gave her an opportunity to explain the patient had complained of pain and was showing other physical symptoms of pain beyond tachycardia (fast heart rate). He was belligerant, berating, and demeaning.

I was impressed by the nurse who later explained the situation to me in detail...including that this doc is known to be difficult with nurses. I appreciated her statement that she would stand by her decision to administer morphine, given the symptoms and circumstances. As nurses, we all too often get trampled on by the doctors who hold so much power. Nurses need to stand by their guns as they are the ones assessing their patients and stay them for 12 hours a shift. Patients don't go to the hospital for the doctor, they go for the nurses.

This is NOT to say I don't appreciate doctors. Like I said, this was my first experience with a truly difficult doctor, which says an awful lot considering I only have 4 weeks left of nursing school! I am very thankful for docs and what they have done in my own health and life. And just like there are bad doctors there are just as many bad nurses.

So how do you come off an experience like the one I had today? Why, go to the "happiest place on earth!" Disneyland! :-) Nothing like a little "Soarin" to calm the indignant spirit. (Thank goodness for annual passes!)

And if you made it to the end of this post...wow, you deserve an award. :-)