Shift Work

Some of the best moments of the weekend:

Delivering a baby girl to a young mother - one of nine sisters and two brothers - with five sisters and one niece present. The youngest of the 9 sisters, aged 16, cut the cord.

A nurse, about to take a break tells her break-relief, "Don't let that Doc near my patient..." Sticking my head out of a delivery room about twenty minutes later I hear that very nurse singing sweetly and find her sitting side-by-side with that very surgeon while he strums away on his ukulele.

One nurse says to another, "You don't believe in God? Not at all?"
"No. Not at all." The first nurse hugs her tightly and then holds her by the shoulders at arms length and asks very seriously, "Then who do you think made Berkeley?"

Dweebs and Assholes

Yesterday, after a very pleasant telephone conversation with my former PI (read:boss) who happens to be a successful MD, I related part of our conversation to The Partner.

"So, the Doc said to me, 'I don't like to hang out with other docs. They're all dweebs and assholes'."

After having sat through a very painful weekly Ob/Gyn Grand Rounds that very morning, lead by a particularly unbearable female doc, I remarked, "It's true. Even the women are assholes." The Partner smartly decided that this would be the title of my upcoming tome on feminism:

"Even the Women Are Assholes: The Unthinkable Thoughts of a Feminist."

Illustration credit, obviously, goes to the late, great Kurt Vonnegut.

The Attending

Did I tell you that I inadvertently called the attending physician on Friday for blood pressure parameters for my patient's Cardizem? Learned my lesson about the hierarchy in a hurry. Yes, in fact, it was totally humiliating. And I'm not sure why, except that I didn't live it down in a hurry... And I did not get the damned parameters.

For those who don't know the system it's like this, top down: attending, resident, intern... with, at my institution of practice, multiples thereof under the attending. "Nurse" is somewhere waaayyy down at the bottom of that totem*, falling fast when one phones the attending instead of the intern.

*Oh wait, we're not a kinship group. There I go, mixing up my careers again!

Surgeons are Super

Surgeons have some of the most amazing writing skills I have yet to read. They are keen observers, excellent historians, and duly self-reflective. This observation is based on notes about a patient that I had this week, one Ms. L., suffering from pancreatic pseudocysts, who suddenly and unexpectedly began vomiting copious[1] amounts of bright red blood[2]. She was in absolutely critical condition by the time we got her to the ICU. Because I followed her there and participated in hanging her blood and plasma for transfusion, watched the endotracheal intubation, etc., and since she and I had been chatting and laughing all morning before the incident, I was anxious to follow-up with her the next day. She apparently underwent surgery early Friday morning and the surgery notes represent a unique literary form that I wish would be published as general interest material. I'd quote from it, but that is not HIPAA compliant, so let me just say to you students out there, if you want to learn in amazing detail and narrative about disease and anatomy, read your patient's surgeon's notes. Absolutely the best tool for learning I have been presented with thus far. (It will probably also be somewhat humbling in terms of differentiating the role of nurse from doctor. I'm just being honest.)

[1] 1000mLs* in about 60 minutes * class II blood loss at 1 hour.
[2] blood that would coagulate before we had time to rinse the basin.

Sinking Nurse

I know that the hospital is a lot less like television than we would like to think, nurses and docs madly rushing to save lives and falling in love all at the same time (mind you, I haven't had a television since about 1994 so this is all based on first season episodes of ER), but in the *actual* hospital, why can't everyone at least pretend to care what's happening to a 20 year-old patient found unconscious on the floor and desating... and why can't the doctors pretend that they think nurses are competent? We're not doctors, but we're also not dimwits. Seriously.

p.s. if you read this blog with any regularity you know that I defend docs to the hilt; I do so because I recognize that we are not doctors. Personally, I accept that I could never be and would never want to be socialized in that way. Still, experiencing the doctor/nurse dilemma first hand, not as a peer researcher, but as a nurse, was, frankly, a proverbial slap in the face. I'm still trying to understand what it means to follow that path. And that understanding is proving to be difficult.