Write an order, dance a jig, beat up your fellow nurses.

"I don't understand why you people are so incompetent."

That's a bad way to begin any conversation. Unless, of course, it's me saying the words, in which case it's perfectly acceptable.

But it's not a good way to begin a conversation with me.

Especially when you're a resident who just started on this unit on the first of the month.

Perhaps especially especially when you're not the sharpest tool in the shed yourself.

Universally Competent and Marvelous Resident (UCMR) was upset that his patient hadn't gotten a number of treatments and medications that UCMR had discussed with one of the nurses. When I say "discussed" I mean *discussed*, as in "Do you think we ought to keep this guy on the high dose pressors he's on, or cut 'em back for a while?" and "Does the wound care service take care of ingrown toenails?" and "What's the procedure for calling a pharm consult for vanc dosing?"

Never mind that these are Very Simple Questions, the answers to which UCMR should've already known. Never mind that the nurse he discussed them with wasn't even the patient's nurse; UCMR had just pulled the poor guy aside during the middle of the night to pepper him with questions.

UCMR lit into me because none of his brilliant ideas had translated into action on anybody else's part.

"You know," I said, trying my best to be gentle, "we can't do anything without an order from you. Just talking about it isn't the same as ordering it, since we don't know exactly what you want."

"Well, you *should*" he protested. "And isn't writing down verbal orders your job anyhow? I don't have time for that shit."

"A verbal order," I replied through my fangs, "should be given as such, not as a series of increasingly idiotic questions. Preferably, it should be given to the nurse caring for the patient. And as for shit, I don't have time for yours. Write your orders and get out of my chair."

Poor UCMR. He really should go into plastics, or some other specialty where people are nicey-nice.

TEAM players

Management has come up with another marvelous idea. This time it's TEAM, a laboring acronym that stands for something like "Teamwork, Enthusiam, Attitude, Managing problems". Here's how it works:

Patients and family members are supposed to fill out little cards the hospital sends 'em a couple weeks after discharge, then mail 'em back, prepaid, with their glowing review of staff members. Each staff member mentioned by name gets a gold star (no, I'm not making this up) next to their name in a file somewhere. When the staff member compiles enough brownie points, they get a nifty T-shirt to wear that proclaims them as a TEAM Player.

Management has its collective crinoline in an uproar. Our unit has gotten the fewest TEAM mentions of any unit since this whole thing started. The assumption on Management's part is that this makes us a bunch of hard-drinkin', dirty-talkin' malcontents without professionalism or caring attitudes.

The reality, of course, is that we have the largest proportion of patients who are totally gorked. Many of 'em either die shortly after they leave us or go to some sort of inpatient rehabilitation. None of those factors make it likely that the patient will suddenly sit up/return from the grave/begin to speak rationally and commend the care he or she got with us. Never mind that the families are dealing with a different set of issues than family members of patients who just had a facelift or breast reduction.

Let's face it, people: Creutzfeld-Jakob disease is not a condition that makes anybody want to fill out a postage-paid postcard six weeks after diagnosis.

So those of us on the Pariah Unit have come up with a plan. We're gonna have white vinyl jackets made up, in the style of 1950's Broadway musical gang members, and have "TEAM PLAYA" embroidered on the backs. We're going to get matching tattoos, set up a wet bar in the nurses' station, and take to dandling Lucky Strikes out of the corners of our mouths. Then we'll mug any nurse we see wearing a TEAM Player T-shirt.

In a few weeks, our reign of terror will be complete. We'll have the hospital under our thumbs. Ice cream sundaes for everybody in OR 7!