Love a nurse. She might save your life.

Today, children, I will introduce a new character in the life of your typical nurse: The Pompous, Ignorant, Condescending Asshole Doctor.

This particular subspecies of MD can be any age, but is usually of the generation that doesn't like nurses and wishes that they still wore caps and cleavage. Generally speaking, the PICA doctor is tall, dignified, homey, and wears a tie to work. It might even be a bow-tie, if you have a specimen of the more gentlemanly sort.

The PICA doc is the one who breezes through the nurse's station on his way to the elevator and informs you that your patient is in "respiratory distress." This will be news to you, since your patient had a normal pulse and respirations ten minutes before, when you last checked on him. When you get through the cloud of dust left by the PICA doc's passing and check on your patient again, you will find him gurgling and wheezing, unable to cough or breathe well, and will have to get things like electrocardiograms and chest X-rays done on an emergent basis.

You'll wonder why this happened. It won't become clear to you until the next day, after multiple nebulizer treatments and suctionings, when the Cynical and Harried Respiratory Therapist starts suctioning out something that looks suspiciously like coffee from your patient's trachea. It'll occur to you that this patient, who is NPO (nothing by mouth) and who has a tube going into his stomach, has been being fed liquids by his family.

His family will confirm this. They'll tell you that PICA doc, who washed his hands of this patient and moved him to another service, told them that it would be a good idea if the patient got liquids by mouth. The PICA doc, in doing so, will have ignored the recommendations of other people--not MDs, but highly qualified--who have said that this patient lacks both the cognitive skills and level of consciousness to swallow.

Let's review the bidding: You have a patient who is just now beginning to come out of the effects of a nasty bleed on the brain. He's being fed through a tube to make sure he doesn't get aspiration pneumonia. He's being followed by the neurologists, not the PICA doc. Yet Mister Doctor Man, without writing official orders, says that it's a fine thing for this patient to be able to breathe in coffee, apple juice, and soda. When your patient begins to have trouble breathing, the PICA doc *leaves the floor* in a blaze of glory.

Think of this. A doctor leaves the area where a patient who has been in his care is in distress. He leaves it up to the nurses and his resident to manage things. In retrospect, I'm glad he did--he might've fucked things up even more if he'd stayed.

There's an unwritten code of conduct in the medical world that bars nurses from screaming down hallways with a claymore in hand to bash stupid people in the head. Thankfully, the service that my patient is now on is populated by humorous, approachable doctors (including the Goateed Greek Neurologist, who promises to teach me to curse in Greek). I know all of their phone numbers now, after that little "respiratory distress" incident and a couple more, and I'm on a first-name basis with some of the residents. Hell, all I have to do with one of the residents is say, "Hey" on the phone and he knows who I am.

I'm trying to decide if I want to file an incident report on this one. I doubt it would do much good in the long run--after all, a fairly new nurse writing up an MD with thirty years' experience is like a gnat buzzing around an elephant--but it sure would be satisfying. It would be more satisfying because I know I'm right. The two neurologists with whom I had to discuss the case were flummoxed by the PICA doc's behavior. One of them called it "horseshit." I don't think that's too strong a word.

At least I know whom to avoid on the floor. If ever I get another one of this guy's patients, I'll know that it'll be a battle to keep the person from being hurt by his doctor's stupidity.

Which reminds me. I need to warn the residents on the next service this guy'll be transferred to to *watch out*.